title: Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with a Preoperative Albumin Level of Less Than 4.0 g/dl.
abstract: BACKGROUND
  Hypoalbuminemia may increase the risk of acute kidney injury (AKI). The authors investigated whether the immediate preoperative administration of 20% albumin solution affects the incidence of AKI after off-pump coronary artery bypass surgery.
  
  
  METHODS
  In this prospective, single-center, randomized, parallel-arm double-blind trial, 220 patients with preoperative serum albumin levels less than 4.0 g/dl were administered 100, 200, or 300 ml of 20% human albumin according to the preoperative serum albumin level (3.5 to 3.9, 3.0 to 3.4, or less than 3.0 g/dl, respectively) or with an equal volume of saline before surgery. The primary outcome measure was AKI incidence after surgery. Postoperative AKI was defined by maximal AKI Network criteria based on creatinine changes.
  
  
  RESULTS
  Patient characteristics and perioperative data except urine output during surgery were similar between the two groups studied, the albumin group and the control group. Urine output (median [interquartile range]) during surgery was higher in the albumin group (550 ml [315 to 980]) than in the control group (370 ml [230 to 670]; P = 0.006). The incidence of postoperative AKI in the albumin group was lower than that in the control group (14 [13.7%] vs. 26 [25.7%]; P = 0.048). There were no significant between-group differences in severe AKI, including renal replacement therapy, 30-day mortality, and other clinical outcomes. There were no significant adverse events.
  
  
  CONCLUSIONS
  Administration of 20% exogenous albumin immediately before surgery increases urine output during surgery and reduces the risk of AKI after off-pump coronary artery bypass surgery in patients with a preoperative serum albumin level of less than 4.0 g/dl.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine (E.-H.L., W.-J.K., J.-Y.K., J.-H.C., D.-K.C., J.-Y.S., I.-C.C.) and Department of Thoracic and Cardiovascular Surgery (S.-J.C., C.-H.C., J.-W.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun-Ho
authors.initials: EH
authors.lastname: Lee
authors.forename: Wook-Jong
authors.initials: WJ
authors.lastname: Kim
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Chin
authors.forename: Dae-Kee
authors.initials: DK
authors.lastname: Choi
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Sim
authors.forename: Suk-Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol-Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: In-Cheol
authors.initials: IC
authors.lastname: Choi
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012709:Serum Albumin / Q000032:analysis*; D016896:Treatment Outcome; D014563:Urodynamics
chemical_list: D000418:Albumins; D012709:Serum Albumin