The Renal Effect of 20% Human Albumin Solution Fluid Bolus Therapy in Patients After Cardiac Surgery. A Secondary Analysis of the HAS FLAIR II Randomized Clinical Trial
Abstract
OBJECTIVE
To compare the effects of fluid bolus therapy (FBT) with 20% albumin to crystalloid FBT on the incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) and its severity and duration.
DESIGN
Secondary analysis of the multicenter, parallel-group, open-label, randomized HAS FLAIR-II trial.
SETTING
Six intensive care units.
PARTICIPANTS
Patients who required clinician-determined FBT after cardiac surgery requiring cardiopulmonary bypass.
INTERVENTIONS
Patients were randomized to receive FBT with 20% albumin (up to 400 mL/day) or crystalloid fluid for all FBTs in the intensive care unit.
MEASUREMENTS AND MAIN RESULTS
A total of 452 patients were included in the modified intention-to-treat population (224 in the 20% albumin group and 228 in the crystalloid group). AKI occurred in 54 (24%) patients in the 20% albumin group and 50 (22%) in the crystalloid group (odds ratio: 1.13, 95% confidence interval [CI]: 0.73 to 1.76). However, in patients who developed stages 2 and 3 AKI, those allocated to 20% albumin had a significantly lower median time-weighted average (TWA) creatinine: 144 µmol/L (interquartile range [IQR]: 109 to 162) versus 254 µmol/L (IQR: 182 to 294) than the crystalloid group (difference -105 µmol/L, [95% CI -170 to -41], p = 0.003) and a lower peak serum creatinine (-110 µmol/L [-189 to -32], p = 0.01). The reduced TWA creatinine in the 20% albumin group was seen in patients with both a low (p = 0.04) and normal preoperative serum albumin…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 452 participants or records.
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