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
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Date
2025
Authors
Wigmore, G.J.
Deane, A.M.
Presneill, J.J.
Serpa Neto, A.
Eastwood, G.
Maiden, M.J.
Bihari, S.
Baker, R.A.
Bennetts, J.S.
Ghanpur, R.
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Journal of Cardiothoracic and Vascular Anesthesia, 2025; 39(4):967-974
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Geoffrey J. Wigmore, Adam M. Deane, Jeffrey J. Presneill, Ary Serpa Neto, Glenn Eastwood, Matthew J. Maiden, Shailesh Bihari, Robert A. Baker, Jayme S. Bennetts, Rashmi Ghanpur, James R. Anstey, Jaishankar Raman, Rinaldo Bellomo, for the HAS FLAIR-II Investigators
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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 concentration (p < 0.001). Conclusions: FBT with 20% albumin compared with crystalloid-based regimen did not reduce the occurrence of AKI in patients after cardiac surgery. However, it reduced the severity and duration of stages 2 and 3 AKI.
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© 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)