Albumin Infusion During Dialysis

Evidence Against Albumin Use During Dialysis

The International Collaboration for Transfusion Medicine Guidelines recommends against albumin infusion during kidney replacement therapy for preventing or treating intradialytic hypotension or improving ultrafiltration (Conditional Recommendation, Very Low Certainty of Evidence of Effect) 1
Albumin infusion during dialysis has not demonstrated convincing evidence of improving small-molecule clearance 2, 3
The high cost of albumin (estimated at $20,000 per patient annually) without proven superiority over less expensive alternatives makes it an economically unsustainable option 1

For preventing intradialytic hypotension, alternative strategies are recommended, including higher dialysate calcium concentration, lower dialysate temperature, individualized ultrafiltration rates, and oral vasopressors like midodrine 1
For patients with hypoalbuminemia, ensuring adequate protein intake (1.2-1.3 g/kg body weight/day) is recommended 4, 5
Monitoring and maintaining normalized protein nitrogen appearance (nPNA) of at least 0.9 g/kg/day is also recommended 4, 5
Regular nutritional assessment and consultation with a renal dietitian is advised 4, 5

Maintaining adequate dialysis clearance (Kt/Vurea) as recommended in guidelines is important for addressing hypoalbuminemia 3, 5
Prevention and treatment of catabolic illness is also crucial for managing hypoalbuminemia 4, 5
Regular monitoring of serum albumin levels (at least every 4 months) is recommended 4, 5

The practice of albumin administration is costly without demonstrated benefit for improving clearance or patient-important outcomes 1

Current evidence does not support the routine use of albumin infusion during dialysis to improve clearance 1, 2
The focus should remain on optimizing dialysis parameters, nutritional status, and addressing underlying causes of hypoalbuminemia rather than albumin infusion 4, 5

The International Collaboration for Transfusion Medicine Guidelines (ICTMG) recommends against albumin infusion during kidney replacement therapy for preventing or treating intradialytic hypotension or improving ultrafiltration (Conditional Recommendation, Very Low Certainty of Evidence) 6, 7, 8
Albumin should not be administered during the last hour of dialysis due to reduced effectiveness for intradialytic hypotension prevention and potential loss of this expensive protein through the dialyzer membrane without providing clinical benefit 6, 7