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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 …
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 (http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=18450).
INFECIR: The INFECIR2 Albumin Prevention Study is funded by the European Association for the Study of Liver Disease Chronic Liver Failure Consortium.