ALBICS-AKI
Trial question
What is the effect of an infusion of 20% albumin in cardiac surgery patients at high-risk of AKI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
27.0% female
73.0% male
N = 611
611 patients (167 female, 444 male).
Inclusion criteria: adult patients presenting for on-pump cardiac surgery who are at high-risk of AKI.
Key exclusion criteria: ICU stay > 6 hours following index surgery; preoperative eGFR < 15 mL/min/1.73 m²; serum albumin < 20 g/L; dialysis dependence; previous kidney transplant; receipt of extracorporeal life support or ventricular assist device; objection to the receipt of albumin or blood products.
Interventions
N=307 albumin (continuous infusion of 20% albumin for 15 hours within 6 hours of ICU admission plus usual care).
N=304 usual care (volume resuscitation with crystalloids and/or iso-oncotic serum albumin, blood transfusion, inotropic and vasopressor therapy, and blood glucose control).
Primary outcome
Acute kidney injury
48.9%
43.4%
48.9 %
36.7 %
24.4 %
12.2 %
0.0 %
Albumin
Usual
care
No significant
difference ↔
No significant difference in AKI (48.9% vs. 43.4%; RR 1.13, 95% CI 0.95 to 1.34).
Secondary outcomes
No significant difference in major adverse kidney events at day 28 (10.7% vs. 9.5%; RR 1.13, 95% CI 0.7 to 1.81).
No significant difference in death at day 28 or before hospital discharge (2% vs. 0.7%; RR 2.97, 95% CI 0.6 to 14.6).
No significant difference in the rate of RRT up to day 28 or before hospital discharge (3.3% vs. 2.3%; RR 1.41, 95% CI 0.55 to 3.67).
Safety outcomes
No significant differences in ≥ 1 adverse event including life-threatening arrhythmia, fluid overload, reintubation, readmission to ICU.
Significant difference in blood transfusion (37.8% vs. 29.9%).
Conclusion
In adult patients presenting for on-pump cardiac surgery who are at high-risk of AKI, albumin was not superior to usual care with respect to AKI.
Reference
Yahya Shehabi, Mayurathan Balachandran, Wisam Al-Bassam et al. Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients: The ALBICS AKI Randomized Clinical Trial. JAMA Surg. 2025 Jun 11:e251683. Online ahead of print.
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