Written by Mary Marschner
Spoon Feed
Administration of early albumin to patients in septic shock with acute kidney injury (AKI) was associated with worse outcomes.
Synopsis
This retrospective, multicenter cohort study analyzed 9,988 adult patients with septic shock and kidney impairment across 220 U.S. hospitals to evaluate the impact of early albumin administration on renal replacement therapy (RRT) and mortality. Albumin use was associated with higher rates of the composite primary outcome of RRT or in-hospital mortality (OR 1.29; P<0.001), particularly with 25% hyperoncotic albumin (OR 1.43; P<0.001). Secondary findings included increased rates of RRT, mortality, and acute kidney injury with albumin use. These results suggest caution in using hyperoncotic albumin for patients with septic shock and kidney impairment, requiring further prospective trials to confirm. (AI-assisted)
SHOCKingly, the argument for albumin vs. crystalloid is ongoing
There have been numerous studies with conflicting results regarding the benefit or harm of giving albumin rather than crystalloid in septic patients. This study suggests potential harm, particularly with hyperoncotic albumin administration in patients with sepsis and AKI, but there are several limitations. Mainly, this paper seems to be a statistical masterpiece. It is a retrospective inverse probability weighted cohort study, analyzing a multicenter database, making statistical adjustments, and performing multiple sensitivity analyses to address unknown confounders. However, I found it tough to determine its meaningfulness. Albumin administration is not standard of care, and the dataset didn’t clarify why patients received it. We don’t know the number of pressors used, if lactate levels changed, or ventilatory support needed to infer illness severity or physician/institutional preference. This study was also conducted during an unusual time; over 10% tested COVID-positive, a seemingly small number in late 2020/2021. Will this affect my practice? Nope; for a septic AKI patient, I’ll stick to crystalloids.
Source
Comparative Effectiveness of Albumin vs No Albumin on Renal Replacement Therapy and Mortality in Patients With Septic Shock and Renal Impairment. Chest. 2024 Oct 18:S0012-3692(24)05315-7. doi: 10.1016/j.chest.2024.10.012. Epub ahead of print. PMID: 39426720
