Albumin at 4% could benefit patients with chronic kidney disease undergoing cardiac surgery under extracorporeal circulation

A clinical trial conducted by Dr. Jordi Miralles, from the Anesthesiology and Resuscitation department at the Hospital de Sant Pau, analyzed the influence of albumin on the development of acute kidney injury associated with cardiac surgery under extracorporeal circulation (ECC) in patients with preserved preoperative renal function, compared to the strategy of purging the circuit with a balanced crystalloid solution versus a balanced crystalloid solution with 4% albumin.

The work, in which Dr. Alejandra Espinosa Guerrero, responsible for the Clinical Trials Clinical Research Unit (UICEC) at the Sant Pau Research Institute, participated through the performance of a pharmacoeconomic substudy, revealed a potential benefit of using 4% albumin as a purge for ECC in patients with preoperative renal function values at the lower limit, according to a post hoc analysis of the study data.

The results confirmed that the use of 4% albumin in ECC in patients with preserved renal function significantly reduces the direct costs associated with cardiac surgery, although clinically significant differences in the development of kidney injury were not detected overall in patients during the first five days after intervention between the two studied groups, according to the results found by Dr. Miralles.

Specifically, one of the most noteworthy aspects of the pharmacoeconomic study was the evidence that the use of 4% albumin as a purge for ECC reduces costs per patient per year by up to €650 compared to conventional treatment with crystalloid solution alone, making 4% albumin potentially more cost-effective in the long term.

Dr. Espinosa explains that it was found that in patients with preserved renal function, no clinical benefit was observed but an economic one, and it would be interesting to continue with a line of research focused on evaluating the effect of albumin in patients undergoing cardiac surgery under ECC with preoperative chronic kidney disease, since “the results of the post-hoc analysis in patients with lower glomerular filtration rate values from the study reveal a trend towards a benefit not only at the clinical level but also in terms of quality of life for the patient, possibly increasing up to 1 month of life in full health”.

In addition to studying the potential clinical benefit, the new study would incorporate a pharmacoeconomic substudy to assess the potential incorporation of albumin into daily clinical practice in these types of patients within the National Health System.

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