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2017 ; 6
(4
): 176-187
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Causal relationship between hypoalbuminemia and acute kidney injury
#MMPMID28729966
Wiedermann CJ
; Wiedermann W
; Joannidis M
World J Nephrol
2017[Jul]; 6
(4
): 176-187
PMID28729966
show ga
Our meta-analysis published in 2010 provided evidence that low levels of serum
albumin (hypoalbuminemia) are a significant independent predictor of acute kidney
injury (AKI) and death following AKI. Since then, a large volume of additional
data from observational clinical studies has been published further evaluating
the relationship between serum albumin and AKI occurrence. This is an updated
review of the literature to re-evaluate the hypothesis that hypoalbuminemia is
independently associated with increased AKI risk. Eligible studies published from
September 2009 to December 2016 were sought in PubMed (MEDLINE) and forty-three
were retained, the great majority being retrospective observational cohort
studies. These included a total of about 68000 subjects across a diverse range of
settings, predominantly cardiac surgery and acute coronary interventions,
infectious diseases, transplant surgery, and cancer. Appraisal of this latest
data set served to conclusively corroborate and confirm our earlier hypothesis
that lower serum albumin is an independent predictor both of AKI and death after
AKI, across a range of clinical scenarios. The body of evidence indicates that
hypoalbuminemia may causally contribute to development of AKI. Furthermore,
administration of human albumin solution has the potential to prevent AKI; a
randomized, controlled study provides evidence that correcting hypoalbuminemia
may be renal-protective. Therefore, measurement of serum albumin to diagnose
hypoalbuminemia may help identify high-risk patients who may benefit from
treatment with exogenous human albumin. Multi-center, prospective, randomized,
interventional studies are warranted, along with basic research to define the
mechanisms through which albumin affords nephroprotection.