Human albumin for intradialytic hypotension in haemodialysis patients.
Author(s): Fortin PM, Bassett K, Musini VM.
Affiliation(s): Department of Anesthesiology, Pharmacology and Therapeutics, University of
British Columbia, 2176 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3.
Publication date & source: 2010, Cochrane Database Syst Rev. , (11):CD006758
BACKGROUND: Intradialytic hypotension (IDH) occurs in 20% to 55% of haemodialysis
sessions and is more frequent among patients on long-term haemodialysis.
Symptomatic IDH is generally defined as a decrease in systolic blood pressure
(BP) of at least 10 mm Hg or a systolic BP less than 100 mm Hg, with symptoms
such as cramps, nausea, vomiting, and dizziness. IDH is managed acutely by volume
expansion through the intravenous administration of fluids.
OBJECTIVES: To compare the benefits and harms of volume expansion with human
albumin, alone or in combination with crystalloid or non-protein colloids, for
treating IDH in haemodialysis patients.
SEARCH STRATEGY: The Cochrane Renal Group's Specialised Register and the Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue
9) MEDLINE (1966 to Oct 2009), and EMBASE (1980 to Oct 2009) were searched.
SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs as well as
randomised crossover studies were to be included.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and
assessed trial quality. Relative risk (RR) was to be used to analyse dichotomous
variables and mean difference (MD) used to analyse continuous variables.
MAIN RESULTS: One double blind randomised crossover trial met the inclusion
criteria and compared 5% albumin to normal saline in patients with a previous
history of IDH. Results from 45 assessable participants did not lead to rejection
of the null hypothesis of no difference between 5% albumin and normal saline in
the primary outcome measure of percentage target ultrafiltration achieved, nor in
11/12 secondary outcomes. Additional (unblinded) saline was given less often when
5% albumin was used compared with saline (16% versus 36%, P = 0.04). However, the
volume of additional fluid administered was similar in both groups. There were no
significant differences in the nursing time required to treat IDH and the time to
restore BP.
AUTHORS' CONCLUSIONS: No randomised or controlled trial was identified comparing
albumin to crystalloids (other than normal saline) or non-protein colloids, or a
combination of both, in the treatment of symptomatic hypotension during
dialysis. One double blind crossover RCT in 45 assessable patients showed that 5%
albumin is not superior to normal saline for the treatment of symptomatic
hypotension in maintenance haemodialysis patients with a previous history of IDH.
Given the cost and relative rarity of albumin use compared to saline, saline
should be first line of therapy for treatment of IDH in stable dialysis patients.
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