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Intensive Care Medicine

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Open Access 01.10.2010 | Systematic Review

Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies

verfasst von: Christian J. Wiedermann, Wolfgang Wiedermann, Michael Joannidis

Erschienen in: Intensive Care Medicine | Ausgabe 10/2010

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Abstract

Purpose

To test the hypothesis that hypoalbuminemia is independently associated with increased risk of acute kidney injury (AKI).

Methods

A meta-analysis was performed of observational clinical studies evaluating the relationship between serum albumin level and the occurrence of AKI by multivariate methods. Additionally, the impact was assessed of lower serum albumin on mortality in patients who developed AKI. Eligible studies were sought by multiple methods, and adjusted odds ratios (OR) were quantitatively combined using a random effects model.

Results

Seventeen clinical studies with 3,917 total patients were included: 11 studies (6 in surgical or intensive care unit patients and 5 in other hospital settings) evaluating the influence of serum albumin on AKI incidence and 6 studies describing the relationship between serum albumin and mortality among patients who had developed AKI. Lower serum albumin was an independent predictor both of AKI and of death after AKI development. With each 10 g L⁻¹ serum albumin decrement, the odds of AKI increased by 134%. The pooled OR for AKI was 2.34 with a 95% confidence interval (CI) of 1.74–3.14. Among patients who had developed AKI, the odds of death rose 147% (pooled OR 2.47, 95% CI 1.51–4.05) with each 10 g L⁻¹ serum albumin decrement.

Conclusions

This meta-analysis provides evidence that hypoalbuminemia is a significant independent predictor both of AKI and of death following AKI development. Serum albumin determinations may be of utility in identifying patients at increased risk for AKI or for death after AKI. Controlled studies are warranted to assess interventions aimed at correcting hypoalbuminemia.

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Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058CrossRefPubMed

Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG (2009) Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 35:1692–1702CrossRefPubMed

de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F (2000) Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 26:915–921CrossRefPubMed

Joannidis M, Metnitz PG (2005) Epidemiology and natural history of acute renal failure in the ICU. Crit Care Clin 21:239–249CrossRefPubMed

Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM (2003) Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 237:319–334CrossRefPubMed

Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9:1–30PubMed

Rich MW, Keller AJ, Schechtman KB, Marshall WG Jr, Kouchoukos NT (1989) Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumin. Am J Cardiol 63:714–718CrossRefPubMed

Rich MW, Crecelius CA (1990) Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study. Arch Intern Med 150:1237–1242CrossRefPubMed

Contreras AM, Ramírez M, Cueva L, Alvarez S, de Loza R, Gamba G (1994) Low serum albumin and the increased risk of amikacin nephrotoxicity. Rev Invest Clin 46:37–43PubMed

10.

Chertow GM, Lazarus JM, Paganini EP, Allgren RL, Lafayette RA, Sayegh MH (1998) Predictors of mortality and the provision of dialysis in patients with acute tubular necrosis. The Auriculin Anaritide Acute Renal Failure Study Group. J Am Soc Nephrol 9:692–698PubMed

11.

Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Riley LJ (1999) Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure. Kidney Int 56:1058–1063CrossRefPubMed

12.

Lins RL, Elseviers M, Daelemans R, Zachee P, Gheuens E, Lens S, De Broe ME (2000) Prognostic value of a new scoring system for hospital mortality in acute renal failure. Clin Nephrol 53:10–17PubMed

13.

Létourneau I, Dorval M, Bélanger R, Légaré M, Fortier L, Leblanc M (2002) Acute renal failure in bone marrow transplant patients admitted to the intensive care unit. Nephron 90:408–412CrossRefPubMed

14.

Kim GH, Oh KH, Yoon JW, Koo JW, Kim HJ, Chae DW, Noh JW, Kim JH, Park YK (2003) Impact of burn size and initial serum albumin level on acute renal failure occurring in major burn. Am J Nephrol 23:55–60CrossRefPubMed

15.

Chawla LS, Abell L, Mazhari R, Egan M, Kadambi N, Burke HB, Junker C, Seneff MG, Kimmel PL (2005) Identifying critically ill patients at high risk for developing acute renal failure: a pilot study. Kidney Int 68:2274–2280CrossRefPubMed

16.

Dharan KS, John GT, Antonisamy B, Kirubakaran MG, Jacob CK (2005) Prediction of mortality in acute renal failure in the tropics. Ren Fail 27:289–296PubMed

17.

Boyle JM, Moualla S, Arrigain S, Worley S, Bakri MH, Starling RC, Heyka R, Thakar CV (2006) Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation. Am J Kidney Dis 48:787–796CrossRefPubMed

18.

Cabezuelo JB, Ramírez P, Ríos A, Acosta F, Torres D, Sansano T, Pons JA, Bru M, Montoya M, Bueno FS, Robles R, Parrilla P (2006) Risk factors of acute renal failure after liver transplantation. Kidney Int 69:1073–1080CrossRefPubMed

19.

Mahajan S, Tiwari S, Bharani R, Bhowmik D, Ravi S, Agarwal SK, Tiwari SC (2006) Spectrum of acute renal failure and factors predicting its outcome in an intensive care unit in India. Ren Fail 28:119–124CrossRefPubMed

20.

Sezer MT, Demir M, Gungor G, Senol A (2006) Predictors of mortality in patients with acute renal failure. Acta Medica (Hradec Kralove) 49:183–188

21.

Drawz PE, Miller RT, Sehgal AR (2008) Predicting hospital-acquired acute kidney injury—a case-controlled study. Ren Fail 30:848–855CrossRefPubMed

22.

Park J, Chung HC, Lee JS, Lee BM, Kim DM, Hwang JC, Jo MW, Noh M, Shin JW (2008) Acute kidney injury after transarterial chemoembolization for hepatocellular carcinoma: a retrospective analysis. Blood Purif 26:454–459CrossRefPubMed

23.

Hung CC, Liu WC, Kuo MC, Lee CH, Hwang SJ, Chen HC (2009) Acute renal failure and its risk factors in Stevens-Johnson syndrome and toxic epidermal necrolysis. Am J Nephrol 29:633–638CrossRefPubMed

24.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212CrossRefPubMed

25.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31CrossRefPubMed

26.

Dawidson IJ, Sandor ZF, Coorpender L, Palmer B, Peters P, Lu C, Sagalowsky A, Risser R, Willms C (1992) Intraoperative albumin administration affects the outcome of cadaver renal transplantation. Transplantation 53:774–782CrossRefPubMed

27.

Pockaj BA, Yang JC, Lotze MT, Lange JR, Spencer WF, Steinberg SM, Topalian SL, Schwartzentruber DJ, White DE, Rosenberg SA (1994) A prospective randomized trial evaluating colloid versus crystalloid resuscitation in the treatment of the vascular leak syndrome associated with interleukin-2 therapy. J Immunother 15:22–28CrossRef

28.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470PubMed

29.

Levine JS, Koh JS, Triaca V, Lieberthal W (1997) Lysophosphatidic acid: a novel growth and survival factor for renal proximal tubular cells. Am J Physiol 273:F575–F585PubMed

30.

Iglesias J, Abernethy VE, Wang Z, Lieberthal W, Koh JS, Levine JS (1999) Albumin is a major serum survival factor for renal tubular cells and macrophages through scavenging of ROS. Am J Physiol 277:F711–F722PubMed

31.

Burleson RL, Jones DB, Yenikomshian AM, Cornwall C, DeVoe C, DeRito J (1978) Clinical renal preservation by cryoperfusion with an albumin perfusate: renal perfusion with albumin. Arch Surg 113:688–692PubMed

32.

Kaufmann MA, Castelli I, Pargger H, Drop LJ (1995) Nitric oxide dose-response study in the isolated perfused rat kidney after inhibition of endothelium-derived relaxing factor synthesis: the role of serum albumin. J Pharmacol Exp Ther 273:855–862PubMed

33.

Gerkens JF (1990) Reproducible vasodilatation by platelet-activating factor in blood- and Krebs-perfused rat kidneys is albumin-dependent. Eur J Pharmacol 177:119–126CrossRefPubMed

34.

Zamlauski-Tucker M, Cohen JJ (1988) Effect of substrate-free albumin on perfused rat kidney function. Ren Physiol 10:352–360PubMed

35.

MacPhee PJ, Michel CC (1995) Fluid uptake from the renal medulla into the ascending vasa recta in anaesthetized rats. J Physiol 487:169–183PubMed

36.

Dixon R, Brunskill NJ (1999) Activation of mitogenic pathways by albumin in kidney proximal tubule epithelial cells: implications for the pathophysiology of proteinuric states. J Am Soc Nephrol 10:1487–1497PubMed

37.

Lee YJ, Han HJ (2008) Albumin-stimulated DNA synthesis is mediated by Ca²⁺/PKC as well as EGF receptor-dependent p44/42 MAPK and NF-κB signal pathways in renal proximal tubule cells. Am J Physiol Renal Physiol 294:F534–F541CrossRefPubMed

38.

Joannidis M, Druml W, Forni LG, Groeneveld AB, Honore P, Oudemans-van Straaten HM, Ronco C, Schetz MR, Woittiez AJ (2010) Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM. Intensive Care Med 36:392–411CrossRefPubMed

39.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256CrossRefPubMed

40.

Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, Castells L, Vargas V, Soriano G, Guevara M, Ginès P, Rodés J (1999) Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 341:403–409CrossRefPubMed

41.

Chen T-A, Tsao Y-C, Chen A, Lo G-H, Lin C-K, Yu H-C, Cheng L-C, Hsu P-I, Tsai W-L (2009) Effect of intravenous albumin on endotoxin removal, cytokines, and nitric oxide production in patients with cirrhosis and spontaneous bacterial peritonitis. Scand J Gastroenterol 44:619–625CrossRefPubMed

42.

Fernández J, Monteagudo J, Bargallo X, Jiménez W, Bosch J, Arroyo V, Navasa M (2005) A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology 42:627–634CrossRefPubMed

43.

Ortega R, Ginès P, Uriz J, Cárdenas A, Calahorra B, De Las Heras D, Guevara M, Bataller R, Jiménez W, Arroyo V, Rodés J (2002) Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 36:941–948PubMed

44.

Mitzner SR, Stange J, Klammt S, Risler T, Erley CM, Bader BD, Berger ED, Lauchart W, Peszynski P, Freytag J, Hickstein H, Loock J, Löhr J-M, Liebe S, Emmrich J, Korten G, Schmidt R (2000) Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl 6:277–286CrossRefPubMed

45.

Elias MM, Comin EJ, Grosman ME, Galeazzi SA, Rodriguez Garay EA (1982) Inhibitory effect of unconjugated bilirubin on p-aminohippurate transport in rat kidney cortex slices. Biochim Biophys Acta 693:265–272CrossRefPubMed

46.

Elias MM, Comin EJ, Grosman ME, Galeazzi SA, Rodriguez Garay EA (1987) Possible mechanism of unconjugated bilirubin toxicity on renal tissue. Comp Biochem Physiol A Comp Physiol 87:1003–1007CrossRefPubMed

47.

Fliser D, Zurbrüggen I, Mutschler E, Bischoff I, Nussberger J, Franek E, Ritz E (1999) Coadministration of albumin and furosemide in patients with the nephrotic syndrome. Kidney Int 55:629–634CrossRefPubMed

Titel: Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies
verfasst von: Christian J. Wiedermann
Wolfgang Wiedermann
Michael Joannidis
Publikationsdatum: 01.10.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 10/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1928-z

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