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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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    • Collaborators ATTIRE Trial Management Committee: E. Forrest, Glasgow Royal Infirmary Hospital; S. Ryder, Nottingham University NHS Trust; G. Wright, Basildon and Thurrock University Hospitals NHS Foundation Trust; J. Portal, University Hospitals Bristol NHS Foundation Trust; J. O'Beirne, Royal Free Hospital NHS Foundation Trust, London; Z. Shabir, UCL Comprehensive Clinical Trials Unit (CCTU); S. Skene UCL CCTU; T. Chandler UCL CCTU; J. Garcia-Hernandez, UCL CCTU; James Blackstone UCL CCTU.

    • Contributors AOB: first draft and review. LC: drafting and review. ATTIRE Trial Management Committee: discussion and reviewed.

    • Funding Wellcome Trust (164699), Department of Health (164699).

    • Competing interests None declared.

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

    • i ATTIRE: Albumin to prevent infection in chronic liver failure is an NIHR portfolio-adopted study funded by The Wellcome Trust and Department of Health under the Health Innovation Challenge Fund (

      INFECIR: The INFECIR2 Albumin Prevention Study is funded by the European Association for the Study of Liver Disease Chronic Liver Failure Consortium.