Colloidal and Pharmacological Activity of Albumin in Clinical Fluid Management: Recent Developments

Human albumin is extensively used and investigated in clinical fluid management. Whether albumin confers sufficient benefit to justify its cost has been a subject of enduring controversy. A 2003 systematic review assembled evidence of benefit, but uncertainty has persisted. Abundant additional data have been newly reported, and this review provides an update. Major recent developments include the largest ever single randomized trial in the field of fluid management as well as the largest ever meta-analysis of randomized trials in the field. The randomized trial confirmed the safety of albumin in intensive care unit patients, while the meta-analysis demonstrated that albumin administration reduces morbidity in broad populations of acutely ill hospitalized patients. In liver disease, new randomized trials have shown that albumin can reduce morbidity as an adjunct to paracentesis and improve circulatory function in spontaneous bacterial peritonitis. Large observational studies have provided evidence of a survival advantage among cardiac surgery patients receiving albumin rather than artificial colloids. For extracorporeal circuit priming during cardiopulmonary bypass, albumin was found in a meta-analysis to maintain platelet counts and fluid balance more effectively than crystalloid. Randomized trials in both cardiac and noncardiac surgery indicated less impairment of coagulation by albumin than hydroxyethyl starch. Improved oxygenation, augmented loss of excess fluid and reduced morbidity after albumin supplementation were demonstrated in a randomized trial of hypoalbuminemic patients. A large-scale pharmacovigilance study showed serious adverse events in albumin recipients to be rare. Emerging evidence has further supported many of the current uses of albumin in fluid management.