JAMA Surg

Albumin infusion post-cardiac surgery linked to higher AKI risk

June 24, 2025

Study details: The ALBICS acute kidney injury (AKI) trial was a multicenter, randomized, open-label study conducted across 7 centers in Australia and Italy from 2019 to 2024. It enrolled 611 high-risk cardiac surgery patients to evaluate whether a 300-mL infusion of 20% albumin over 15 hours postoperatively reduced the incidence of AKI. Participants were stratified by estimated glomerular filtration rate (eGFR) > or <60 mL/min/1.73 m².

Results: AKI occurred in 48.9% of patients in the albumin group vs. 43.4% in the usual care group (strata-adjusted relative risk, 1.12; 95% confidence interval [CI], 1.04–1.21; P = .003). The risk was even higher among those with reduced baseline kidney function (adjusted RR, 1.14; 95% CI, 1.07–1.22; P < .001). More patients in the albumin group required blood transfusions (37.8% vs. 29.9%; P = .04), though other secondary outcomes didn’t differ significantly.

Clinical impact: The results don’t support the routine use of hyperoncotic albumin infusion in high-risk cardiac surgery patients. Reconsider routine postoperative albumin use in this population, particularly in those with impaired baseline renal function, and await further evidence before adopting this strategy broadly.

Source:

Shehabi Y, et al; ALBICS AKI Study Investigators. (2025, June 11). JAMA Surg. Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients: The ALBICS AKI Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40498523/