Hyperoncotic Albumin Solution in Continuous Renal Replacement Therapy Patients

Zachary O'Brien, Mark Finnis, Martin Gallagher, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)


Aim: The aim of this study was to investigate the association of hyperoncotic (20%) human albumin solution (HAS) with outcomes among critically ill patients receiving continuous renal replacement therapy (RRT). Methods: Analysis of the Randomized Evaluation of Normal versus Augmented Level (RENAL) RRT trial data. Results: Of 1,508 patients, 771 (51%) received albumin. Of these, 345 (45%) received 4% HAS only, 155 (20%) received 20% HAS only, and 271 (35%) received both. Patients who received combined 4% and 20% HAS were more severely ill, received more days of RENAL trial therapy and required mechanical ventilation for longer. Mean daily fluid balance was -288 mL (-904 to 261) with 20% HAS only versus 245 mL (-248 to 1,050) with 4% HAS only (p < 0.001). On Cox proportional hazards regression, 20% HAS exposure was not associated with greater 90-day mortality (odds ratio 1.12, 95% confidence interval [CI]: 0.77-1.62; p = 0.55) or longer recovery to RRT independence (sub-hazard ratio 1.04, 95% CI: 0.84-1.30; p = 0.70) compared to those who received 4% HAS only. Conclusions: RENAL trial patients commonly received albumin in varying concentrations. The administration of 20% HAS was associated with a more negative fluid balance but was not independently associated with increased mortality or RRT dependence when compared to 4% HAS only.

Original languageEnglish
Pages (from-to)590-599
Number of pages10
JournalBlood Purification
Issue number7
Publication statusPublished - Jul 2022


  • Acute kidney injury
  • Hyperoncotic albumin
  • Renal replacement therapy

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