Causal relationship between hypoalbuminemia and acute kidney injury

Abstract

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.

Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study

“…Cumulative evidence have shown that hypoalbuminemia is an important risk factor for postoperative AKI in various clinical settings [8][9][10][11][12]. However, in surgical settings, studies were mainly focused on cardiac surgery and transplant surgery [11,12,[21][22][23].…”

“…Hypoalbuminemia is a well-established risk factor for increased morbidity and mortality in acutely ill patients [7]. The association between hypoalbuminemia and AKI is consistently evident in many observational studies conducted across different clinical settings, mainly focusing on infectious diseases, cancer, cardiac surgery, and transplant surgery [8][9][10][11][12]. Although the underlying mechanisms for this association are not fully elucidated, serum albumin may play a protection role in the maintenance of renal perfusion, preservation of proximal tubular integrity and function, binding of endogenous toxins and nephrotoxic drugs, prevention of oxidative damage, and delivery of protective lysophosphatidic acid [13,14].…”

Preoperative hypoalbuminemia was associated with acute kidney injury in high risk patients following non-cardiac surgery: a retrospective cohort study

“…Cumulative evidence have shown that hypoalbuminemia is an important risk factor for postoperative AKI in various clinical settings [8][9][10][11][12]. However, in surgical settings, researches were mainly focused on cardiac surgery and transplant surgery [11,12,[21][22][23].…”

“…Hypoalbuminemia is a well-established risk factor for increased morbidity and mortality in acute illed patients [7]. The association between hypoalbuminemia and AKI is consistently evident in a wealth of observational studies conducted across different clinical settings, mainly focusing on infectious diseases, cancer, cardiac surgery and transplant surgery [8][9][10][11][12]. Although the underlying mechanisms for this association are not fully elucidated, serum albumin may play a protection role in maintenance of renal perfusion, preservation of proximal tubular integrity and function, binding of endogenous toxins and nephrotoxic drugs, prevention of oxidative damage and delivery of protective lysophosphatidic acid [13,14].…”

The Effect of Preoperative Albumin Level on Renal Function in Diabetic Patients in Cardiac Surgery

“…Açık kalp cerrahisi planlanan bazı hastalarda preoperatif dönemde veya postoperatif dönemde kardiyopulmoner baypasa bağlı olarak albümin düşüklüğü görülebilir. Hipoalbüminemi akut böbrek hasarı için bir ön belirteç olarak kabul edilmektedir [8,9] . Postoperatif dönemde hipoalbüminemi ile ABH birlikteliği artmış morbidite ve mortalite ile ilişkilidir [10] .…”