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Abstract
Introduction Haemodynamic alterations in liver failure are associated with endothelial dysfunction, a pro-inflammatory state and sympathetic activation which lead to disturbed RBF autoregulation and renal failure. Albumin is a multifunctional protein that has been shown in several studies to prevent and treat renal dysfunction in patients with advanced cirrhosis and liver failure. We hypothesised that the beneficial effects of albumin in cirrhosis is likely to be through mechanisms in addition to volume expansion. The aims of the study were to investigate the effects of albumin on systemic and renal haemodynamics, inflammation and endothelial dysfunction in refractory ascites and patients with acute kidney injury (AKI) in the setting of ACLF.
Methods Twenty-two patients were recruited [Group 1, n=12, refractory ascites; Group 2, n=10 patients with AKI admitted with an acute deterioration of their liver function due to either alcoholic hepatitis or infection]. Both groups were treated with Albumin 60 g/d over 3–4 days. Cardiac output (CO) and renal blood flow (RBF) haemodynamics were measured. Endothelial dysfunction was assessed through measurement of von Willebrand factor (vWF) and serum nitrite (NO) levels. F2α Isoprostanes (F2α), resting neutrophil burst and Interleukin (IL)-6 were quantified as markers of oxidative stress, endotoxemia and inflammation respectively.
Results Albumin therapy was associated with significant improvements in haemodynamic parameters (increased RBF, MAP, decreased CO, HR; p<0.05) which resulted in a shift in the RBF autoregulation curve towards normalisation (Abstract PTU-016 figure 1). In parallel, improvement of renal dysfunction (creatinine, creatinine clearance and Na+ excretion; p<0.05 each), sympathetic activation (noradrenaline levels; p<0.01), inflammation/oxidative stress (F2α and neutrophil burst; p<0.05), endothelial dysfunction (vWF and NO metabolism p<0.05) and the functional capacity of albumin (IMAR p<0.005) was observed. Restoration of RBF correlated inversely with change in vWF (r2=0.55, p<0.001).
Conclusion This study suggests that albumin infusion improves albumin function which has pleiotropic effects and results in a reduction in inflammation and improvement in endothelial function leading to improved systemic haemodynamics and renal blood flow autoregulation.
Competing interests None declared.