J Clin Outcomes Manage
The role of albumin in the management of hepatorenal syndrome: a systematic review
Mudireddy PR, Agarwal R, Williams K
ABSTRACT Objective: To evaluate the available evidence supporting the use of albumin for diagnosis and treatment of hepatorenal syndrome (HRS). Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for articles published in English between 1966 and March 2013. To evaluate the role of albumin in the diagnosis of HRS, we looked for trials comparing albumin to other plasma expanders. To evaluate the role of albumin in the treatment of HRS, we looked for trials comparing vasoconstrictor plus albumin to vasoconstrictor alone. Results: There were no trials evaluating the efficacy of albumin versus other volume expanders in the diagnosis of HRS. There were 4 studies (all nonrandomized) with a total 169 patients comparing the improvement in creatinine in HRS patients treated with vasoconstrictor (terlipressin) plus albumin to vasoconstrictor alone. In the terlipressin plus albumin group, the response rate (defined as any improvement in creatinine from baseline) was 65.5% vs 46.8% in terlipressin alone group. In the only study (total 21 patients) where survival data was available, survival rate at 1 month was higher in the vasoconstrictor plus albumin group (92% vs. 25%). A formal meta-analysis was not performed due to the lack of randomized controlled studies and heterogeneity in study designs and outcome definition. Conclusions: The use of albumin along with terlipressin significantly improved the response rates (defined as any decrease in serum creatinine) in patients with HRS when compared with terlipressin alone. There is insufficient data to comment on HRS reversal rate (defined as decrease in serum creatinine to below 1.5 mg/dL) and impact on survival. We found no evidence to support use of albumin over normal saline for plasma expansion for diagnosis of HRS.
Clinical Review Article
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