Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury

• Published in: Liver international 2015-02, Vol.35 (2), p.335-343
• Main Authors: Garcia-Martinez, Rita, Noiret, Lorette, Sen, Sambit, Mookerjee, Rajeshwar, Jalan, Rajiv
• Format: Article
• Language: English
• Subjects: acute kidney injury; Acute Kidney Injury - drug therapy; Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Adult; albumin; cirrhosis; endothelial dysfunction; Enzyme-Linked Immunosorbent Assay; Female; Hemodynamics - drug effects; human; Humans; Infusions, Intravenous; Interleukin-6 - blood; Liver Cirrhosis - complications; Male; Malondialdehyde - metabolism; Middle Aged; refractory ascites; renal blood flow; Renal Circulation - drug effects; Respiratory Burst - drug effects; Retrospective Studies; Serum Albumin - administration & dosage; Serum Albumin - pharmacology; Statistics, Nonparametric; Thiobarbituric Acid Reactive Substances; von Willebrand Factor - metabolism
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.12528

Background & Aims In cirrhotic patients with renal failure, renal blood flow autoregulation curve is shifted to the right, which is consequent upon sympathetic nervous system activation and endothelial dysfunction. Albumin infusion improves renal function in cirrhosis by mechanisms that are incompletely understood. We aimed to determine the effect of albumin infusion on systemic haemodynamics, renal blood flow, renal function and endothelial function in patients with acute decompensation of cirrhosis and acute kidney injury. Methods Twelve patients with refractory ascites and 10 patients with acute decompensation of cirrhosis and acute kidney injury were studied. Both groups were treated with intravenous albumin infusion, 40–60 g/days over 3–4 days. Cardiac and renal haemodynamics were measured. Endothelial activation/dysfunction was assessed using von Willebrand factor and serum nitrite levels. F2α Isoprostanes, resting neutrophil burst and noradrenaline levels were quantified as markers of oxidative stress, endotoxemia and sympathetic activation respectively. Results Albumin infusion leads to a shift in the renal blood flow autoregulation curve towards normalization, which resulted in a significant increase in renal blood flow. Accordingly, improvement of renal function was observed. In parallel, a significant decrease in sympathetic activation, inflammation/oxidative stress and endothelial activation/dysfunction was documented. Improvement of renal blood flow correlated with improvement in endothelial activation (r = 0.741, P