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Drug Insight: the role of albumin in the management of chronic liver disease

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 43–51 (2007)Cite this article

Abstract

Albumin is the most abundant protein in the circulation. Its main physiologic function is to maintain colloid osmotic pressure. Better understanding of albumin's other physiologic functions has expanded its application beyond maintenance of intravascular volume. In patients with cirrhosis, albumin has been used as an adjunct to diuretics to improve the diuretic response. It has also been used to prevent circulatory dysfunction developing after large-volume paracentesis. Newer indications in cirrhotic patients include preventing hepatorenal syndrome in those with spontaneous bacterial peritonitis, and treating established hepatorenal syndrome in conjunction with vasoconstrictor therapies. The use of albumin for many of these indications is controversial, mostly because of the paucity of well-designed, randomized, controlled trials. The cost of albumin infusions, lack of clear-cut benefits for survival, and fear of transmitting unknown viruses add to the controversy. The latest indication for albumin use in cirrhotic patients is extracorporeal albumin dialysis, which has shown promise for the treatment of hepatic encephalopathy; its role in hepatorenal syndrome or acute on chronic liver failure has not been established. Efforts should be made to define the indications for albumin use, dose of albumin required and predictors of response, so that patients gain the maximum benefit from its administration.

Key Points

  • Albumin is the most abundant protein in human serum. Its major function is to exert osmotic pressure, but it also has ligand binding, antioxidant and endothelial stabilizing properties

  • The use of albumin in patients with cirrhosis is controversial; there is evidence to support its use in the management of complications of cirrhosis, but there are also arguments against its use in cirrhosis, especially since albumin infusions are costly and survival has not been shown to be improved with this treatment

  • Albumin could provide some benefit in reducing the development of postparacentesis circulatory dysfunction, and in reducing the development of renal failure in selected patients with spontaneous bacterial peritonitis

  • In patients with hepatorenal syndrome, the use of albumin in conjunction with vasoconstrictor therapy is common, but albumin has not been shown to provide additional benefit

  • The molecular adsorbent recirculating system has not yet been proven to be a successful treatment for hepatorenal syndrome

  • Future efforts should concentrate on establishing when, how much, and for what indications albumin should be used

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Figure 1: The albumin molecule has three pairs of identical subdomains, which are colored blue, green and red.
Figure 2: Reduction in effective arterial blood volume in cirrhosis.
Figure 3: The molecular adsorbent recirculating system.

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Author notes

  1. Department of Medicine, Toronto General Hospital, 9th floor, North Wing, Room 983, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada florence.wong@utoronto.ca

Authors and Affiliations

  1. F Wong is an Associate Professor and a Staff Hepatologist in the Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.,

    Florence Wong

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The author has received grant support from Gambro Inc, which is one of the companies that supply the MARS machine.

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Wong, F. Drug Insight: the role of albumin in the management of chronic liver disease. Nat Rev Gastroenterol Hepatol 4, 43–51 (2007). https://doi.org/10.1038/ncpgasthep0680

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