|
Randomized clinical trials of hyperoncotic albumin in other indications |
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| Trial |
n |
Indication |
Regimen |
Results |
|
|
||||
| Liver disease |
||||
| Gentilini et al., 1999 [51] |
126 |
Cirrhosis and refractory ascites |
Inpatient treatment with 12.5 g/day 25% albumin plus diuretics vs diuretics alone |
90.5% cumulative treatment response rate in group receiving albumin vs 74.7% in control group (p < 0.05); shorter hospital stay (p < 0.05) in group receiving albumin (20 vs 24 days) resulting in 59% cost savings; no survival difference |
| Sort et al., 1999 [53] |
126 |
Cirrhosis with ascites and spontaneous bacterial peritonitis |
1.5 g/kg 20% albumin within 6 h of diagnosis and 1 g/kg on day 3 vs no albumin; intravenous cefotaxime in both groups |
Renal impairment in 33% of control group vs 10% of albumin recipients (p = 0.002); 29% hospital mortality in control group vs 10% of group receiving albumin (p = 0.01); 41% and 22% mortality, respectively, by 3 months of follow-up (p = 0.03) |
| Fernández et al., 2005 [58] |
20 |
Cirrhosis and spontaneous bacterial peritonitis |
20% albumin vs 6% HES 200/0.5, both administered at 1.5 g/kg after baseline measurements and 1.0 g/kg on day 3 |
Albumin increased mean arterial pressure and decreased plasma renin activity; no improvements in circulatory function in patients receiving HES; 4 of 10 HES recipients developed spontaneous bacterial peritonitis-induced circulatory dysfunction or renal failure, whereas neither complication occurred in any of the 10 patients receiving albumin |
| High-risk neonates |
||||
| McMurray et al., 1948 [35] |
33 |
Premature infants with low birth weight |
3 ml 25 g/dl albumin injected per pound body weight 1–2 times weekly vs no albumin |
8.5 days shorter mean time to regain birth weight in infants receiving albumin (p = 0.02) and significantly fewer illnesses |
| Greenough et al., 1993 [42] |
30 |
Ventilator-dependent ill pre-term infants |
5 ml/kg 20% albumin vs placebo |
Albumin reduced edema based on weight loss (p < 0.01), whereas control group gained weight (p < 0.05); 27% reduction in inspired oxygen requirement after albumin treatment (p < 0.05) with no change in control group |
| Gürkan et al., 2001 [56] |
18 |
Newborns with asphyxia and brain edema |
0.5 g/kg 20% albumin vs routine fluid |
Higher modified Apgar score in group receiving albumin after 24 h (p < 0.001) with difference persisting 8 days; cerebral edema reduced in greater proportion of albumin than control group as judged by head ultrasound; 28% shorter hospital stay in albumin-treated group (p < 0.01) |
| Brain injury |
||||
| Goslinga et al., 1992 [40] |
300 |
Acute ischemic stroke |
Normovolemic hemodilution with 20% albumin vs crystalloids |
In subgroup with normal hematocrit accounting for two-thirds of study population, mortality and disability at 3 months significantly lower among albumin recipients |
| Tomita et al., 1994 [43] |
18 |
Closed head injury |
High-oncotic-pressure therapy with 25% albumin and furosemide vs normal-oncotic-pressure therapy |
Recovery with minimal or no neurological deficit in patients of high-oncotic-pressure therapy group; persistent vegetative state or death in 30% of patients receiving normal-oncotic-pressure therapy |
| Intradialytic hypotension |
||||
| van der Sande et al., 1999 [54] |
10 |
Crossover trial of stable dialysis patients |
20% albumin vs 10% HES 200/0.5 vs saline, in conjunction with ultrafiltration and hemodialysis |
Greater decrease in blood volume with saline than other fluids (p < 0.05) |
| van der Sande et al., 2000 [55] |
9 |
Crossover trial of cardiac-compromised dialysis patients |
100 ml of 20% albumin vs 10% HES 200/0.5 vs 3% hypertonic saline, in conjunction with ultrafiltration and hemodialysis |
Greater intradialytic reductions in systolic blood pressure (p < 0.05) and blood volume (p < 0.05) with hypertonic saline than either albumin or HES |
| Nephrotic syndrome |
||||
| Kosnadi et al., 1987 [38] |
24 |
Children with nephrotic syndrome |
20% albumin + furosemide + prednisone vs human plasma + furosemide + prednisone vs prednisone alone |
Diuresis earlier with albumin + furosemide + prednisone vs prednisone alone (p = 0.011) and percent body weight loss greater (p < 0.01) |
| Fliser et al., 1999 [50] |
9 |
Double-blind, placebo-controlled crossover trial in patients with nephrotic syndrome on standardized salt intake |
200 ml 20% albumin + 0.9% NaCl sham infusion vs 200 ml 20% albumin + 60 mg furosemide vs 60 mg furosemide + sham infusion of 200 ml H2O |
Urinary volume and sodium excretion higher by 20% (p < 0.05 and p < 0.01, respectively) during first 8 h with albumin + furosemide than furosemide alone |
| Na et al., 2001 [57] |
7 |
Crossover trial in patients with nephrotic syndrome |
100 ml 20% albumin vs 5% dextrose followed by 160 mg of furosemide |
Albumin potentiated the diuretic effect of furosemide |
|
HES, hydroxyethyl starch. | ||||
Jacob et al. Critical Care 2008 12:R34 doi:10.1186/cc6812 |
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