Albumin infusion in hepatorenal syndrome-acute kidney injury: New evidence challenges recent consensus

Abstract

Recent consensus guidelines by the ADQI (Acute Disease Quality Initiative) and the ICA (International Club of Ascites) put forth recommendations for the management of acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome-AKI. These recommendations included the use of crystalloids over albumin for first-line volume resuscitation and restricting the use of albumin infusion to 24 h. Whilst based on sound scientific rationale, recent evidence challenges these positions. New studies have provided further evidence in support of the efficacy and safety of albumin infusion in this context, highlighting that a significant proportion of responses occurred between 24 and 48 h. These more recent studies also show that the application of the EASL AKI algorithm is associated with very good response rates and does not significantly delay initiation of terlipressin therapy. Hence, until further data become available, we recommend following the EASL algorithm, particularly regarding the use of 48-hour albumin infusion and established diagnostic criteria.