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Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury

Authors

  • Rita Garcia-Martinez,

    1. Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, UK
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  • Lorette Noiret,

    1. Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, UK
    2. Centre for Mathematics and Physics in the Life Sciences and Experimental Biology (CoMPLEX), University College London, London, Uk
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  • Sambit Sen,

    1. Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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  • Rajeshwar Mookerjee,

    1. Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, UK
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  • Rajiv Jalan

    Corresponding author
    1. Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, UK
    • Correspondence

      Professor Rajiv Jalan, Liver Failure Group,

      UCL Institute for Liver and Digestive Health, the Royal Free Hospital

      Pond Street, London NW3 2PF, UK

      Tel: +44 2074332795

      Fax: +44 2074332871

      e-mail: r.jalan@ucl.ac.uk

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Abstract

Background & Aims

In cirrhotic patients with renal failure, renal blood flow autoregulation curve is shifted to the right, which is consequent upon sympathetic nervous system activation and endothelial dysfunction. Albumin infusion improves renal function in cirrhosis by mechanisms that are incompletely understood. We aimed to determine the effect of albumin infusion on systemic haemodynamics, renal blood flow, renal function and endothelial function in patients with acute decompensation of cirrhosis and acute kidney injury.

Methods

Twelve patients with refractory ascites and 10 patients with acute decompensation of cirrhosis and acute kidney injury were studied. Both groups were treated with intravenous albumin infusion, 40–60 g/days over 3–4 days. Cardiac and renal haemodynamics were measured. Endothelial activation/dysfunction was assessed using von Willebrand factor and serum nitrite levels. F2α Isoprostanes, resting neutrophil burst and noradrenaline levels were quantified as markers of oxidative stress, endotoxemia and sympathetic activation respectively.

Results

Albumin infusion leads to a shift in the renal blood flow autoregulation curve towards normalization, which resulted in a significant increase in renal blood flow. Accordingly, improvement of renal function was observed. In parallel, a significant decrease in sympathetic activation, inflammation/oxidative stress and endothelial activation/dysfunction was documented. Improvement of renal blood flow correlated with improvement in endothelial activation (r = 0.741, P < 0.001).

Conclusions

The data suggest that albumin infusion improves renal function in acutely decompensated cirrhotic patients with acute kidney injury by impacting on renal blood flow autoregulation. This is possibly achieved through endothelial stabilization and a reduction in the sympathetic tone, endotoxemia and oxidative stress.

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