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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dc.contributor.authorWigmore, G.J.
dc.contributor.authorDeane, A.M.
dc.contributor.authorPresneill, J.J.
dc.contributor.authorSerpa Neto, A.
dc.contributor.authorEastwood, G.
dc.contributor.authorMaiden, M.J.
dc.contributor.authorBihari, S.
dc.contributor.authorBaker, R.A.
dc.contributor.authorBennetts, J.S.
dc.contributor.authorGhanpur, R.
dc.contributor.authorAnstey, J.R.
dc.contributor.authorRaman, J.
dc.contributor.authorBellomo, R.
dc.date.issued2025
dc.description.abstractObjective: 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.
dc.description.statementofresponsibilityGeoffrey 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
dc.identifier.citationJournal of Cardiothoracic and Vascular Anesthesia, 2025; 39(4):967-974
dc.identifier.doi10.1053/j.jvca.2024.12.041
dc.identifier.issn1053-0770
dc.identifier.issn1532-8422
dc.identifier.orcidDeane, A.M. [0000-0002-7620-5577]
dc.identifier.orcidMaiden, M.J. [0000-0003-4345-3213]
dc.identifier.urihttps://hdl.handle.net/2440/145996
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.rights© 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/)
dc.source.urihttps://doi.org/10.1053/j.jvca.2024.12.041
dc.subjectacute kidney injury; albumin; cardiac surgery; critical care; creatinine; azotemia
dc.subject.meshHumans
dc.subject.meshPostoperative Complications
dc.subject.meshAlbumins
dc.subject.meshIsotonic Solutions
dc.subject.meshFluid Therapy
dc.subject.meshCardiac Surgical Procedures
dc.subject.meshAged
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshAcute Kidney Injury
dc.subject.meshCrystalloid Solutions
dc.titleThe 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
dc.typeJournal article
pubs.publication-statusPublished

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