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Brexit from current guideline recommendations?
  1. Paolo Angeli1,
  2. Salvatore Piano1,
  3. Vicente Arroyo2,3
  4. on behalf of the International Club of Ascites
  1. 1Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
  2. 2European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
  3. 3European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium, Barcelona, Spain
  1. Correspondence to Professor Paolo Angeli, Unit of Internal Medicine and Hepatology, Department of Medicine (DIMED) and Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Via Giustiniani 2, Padova 35100, Italy; pangeli{at}

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Dear Editor,

We appreciate the interest of O'Brien et al in our position paper recently published in Gut.1 O'Brien et al raised a very important question: is human serum albumin (HSA) the best resuscitation fluid in patients with cirrhosis and acute kidney injury (AKI)? In our minds, as in that of almost all experts in this field, the answer is absolutely yes. This certainty is based on several clinical and experimental evidences and cannot be challenged by studies performed in critically ill patients that are inconsistent for this purpose considering (a) the low percentage of patients with cirrhosis who were included and (b) the modest doses of …

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  • Competing interests VA received grant and research support from Grifols.

  • Provenance and peer review Not commissioned; internally peer reviewed.