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Is human albumin solution really the best resuscitation fluid for patients with advanced cirrhosis?
  1. Alastair O'Brien,
  2. Louise China
  3. on behalf of the ATTIRE Trial Management Committee
    1. University College London, London, UK
    1. Correspondence to Dr Alastair O'Brien, University College London, Rayne Institute, 5 University Street, London WC1E 6BT, UK; rmhaajo{at}

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    Dear Sirs,

    We read with interest the revised consensus recommendations for management of acute kidney injury (AKI) ) in cirrhosis by the International Club of Ascites.1 We are concerned that plasma volume expansion only with albumin is recommended for stage 2 and 3 AKI and do not believe that this represents a balanced view of the available evidence. No one doubts that fluid resuscitation is an integral part of the management of AKI; however, studies to date have not established class 1 evidence for an advantage of the use of albumin over other colloids or crystalloids.

    It can be argued that albumin may represent a superior fluid resuscitation agent in cirrhotic patients. Certainly a …

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