Comparative Effectiveness of Albumin vs No Albumin on Renal Replacement Therapy and Mortality in Patients With Septic Shock and Renal Impairment.

Background: Albumin infusions may be renally protective or harmful in patients with septic shock who have kidney impairment. This can affect the need for renal replacement therapy (RRT) and in-hospital mortality.

Research Question: Does the early use of albumin mitigate the need for RRT or in-hospital mortality in patients with septic shock and kidney impairment on hospital admission?

Study Design And Methods: This was a retrospective, multicenter, inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the United States. Adult patients were included if they had septic shock and kidney impairment on hospital admission. Patients were categorized as those who received albumin (within 24 hours of admission) or no albumin during hospitalization. Proportion of patients with RRT or in-hospital mortality were compared between groups.

Results: Of the 9,988 patients included in the final cohort, 7,929 did not receive albumin and 2,059 received albumin. Patients had a mean ± SD age of 67.8 ± 14.8 years, 46.3% were female, and the mean estimated glomerular filtration rate was 32 ± 12 mL/min/1.73 m on the day of admission. In the weighted cohort, the composite outcome of RRT or in-hospital mortality occurred in 33.8% without albumin and 39.7% with albumin treatment (OR, 1.29; 95% CI, 1.14-1.47; P < .001). There was no significant difference with 5% albumin (OR, 1.07; 95% CI, 0.84-1.37), but there was a significantly increased risk with 25% albumin (OR, 1.43; 95% CI, 1.16-1.76).

Interpretation: In patients with septic shock and kidney impairment on hospital admission, early albumin use may be associated with an increased composite outcome of RRT or in-hospital mortality. This increased risk is most associated with hyperoncotic albumin rather than iso-oncotic albumin.