The Role of Albumin in the Management of Hepatorenal Syndrome: A Systematic Review

Objective:�Toevaluatetheavailableevidencesupport- ingtheuseofalbuminfordiagnosisandtreatmentof� hepatorenalsyndrome�(HRS). •� Methods:� WesearchedMEDLINE,� EMBASE,� and� theCochraneLibraryforarticlespublishedinEng- lishbetween� 1966� andMarch� 2013.� Toevaluate� theroleofalbumininthediagnosisofHRS,� we� lookedfortrialscomparingalbumintootherplasma� expanders.� Toevaluatetheroleofalbumininthe� treatmentofHRS,� welookedfortrialscompar- ingvasoconstrictorplusalbumintovasoconstrictor� alone.� •� Results:�Therewerenotrialsevaluatingtheefficacy� ofalbuminversusothervolumeexpandersinthe� diagnosisofHRS.�Therewere�4�studies�(allnonran- domized)�withatotal�169�patientscomparingtheim- provementincreatinineinHRSpatientstreatedwith� vasoconstrictor�(terlipressin)�plusalbumintovasocon- strictoralone.�Intheterlipressinplusalbumingroup,� theresponserate� (definedasanyimprovementin� creatininefrombaseline)� was� 65.5%� vs� 46.8%� in� terlipressinalonegroup.�Intheonlystudy�(total�21� patients)�wheresurvivaldatawasavailable,�survival� rateat�1�monthwashigherinthevasoconstrictorplus� albumingroup�(92%�vs.�25%).�Aformalmeta-analysis� wasnotperformedduetothelackofrandomizedcon- trolledstudiesandheterogeneityinstudydesignsand� outcomedefinition. •� Conclusions:� Theuseofalbuminalongwithterli- pressinsignificantlyimprovedtheresponserates� (definedasanydecreaseinserumcreatinine)� in� patientswithHRSwhencomparedwithterlipressin� alone.�ThereisinsufficientdatatocommentonHRS� reversalrate�(definedasdecreaseinserumcreati- ninetobelow�1.5�mg/dL)�andimpactonsurvival.�We� foundnoevidencetosupportuseofalbuminover�