Recomendaciones actuales para el uso de albúmina en pacientes con cirrosis hepática: revisión basada en la evidencia
DOI:
https://doi.org/10.59093/27112330.162Palabras clave:
cirrosis hepática, albúmina sérica, paracentesis, peritonitis, lesión renal aguda, síndrome hepatorrenal.Resumen
La albúmina intravenosa se ha consolidado como una intervención terapéutica fundamental en el manejo de múltiples complicaciones de la cirrosis hepática. Su utilidad trasciende la simple expansión de volumen plasmático, ya que participa en múltiples procesos fisiopatológicos, incluyendo la modulación de la respuesta inflamatoria, la estabilización hemodinámica y la protección de la función renal. En las últimas décadas, numerosos estudios han permitido aclarar su rol en escenarios relevantes como la paracentesis de gran volumen, la peritonitis bacteriana espontánea y la lesión renal aguda, incluido el síndrome hepatorrenal, escenario en el que se administra junto con agentes vasoconstrictores. La evidencia acumulada demuestra de forma consistente que su administración mejora la perfusión renal, reduce la activación de sistemas vasoconstrictores compensatorios y contribuye a revertir la disfunción circulatoria característica de la cirrosis avanzada. Cuando se utiliza de manera adecuada y se acompaña de una monitorización estrecha para identificar efectos adversos como la sobrecarga de volumen o las complicaciones isquémicas, su administración permite optimizar los resultados clínicos, y constituye una herramienta terapéutica con impacto relevante en la evolución de una enfermedad compleja y de alta morbimortalidad.
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Referencias bibliográficas
Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: Pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology 2013;58:1836-1846. https://doi.org/10.1002/hep.26338.
Trebicka J, Garcia-Tsao G. Controversies regarding albumin therapy in cirrhosis. Hepatology 2025;81:288-303. https://doi.org/10.1097/HEP.0000000000000521.
Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: A review. JAMA 2023;329:1589-1602. https://doi.org/10.1001/jama.2023.5997.
Belcher JM. Hepatorenal syndrome: Pathophysiology, diagnosis, and treatment. Med Clin North Am 2023;107:781-792. https://doi.org/10.1016/j.mcna.2023.03.009.
Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling S, Nadim M. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021;74:1014-1048. https://doi.org/10.1002/hep.31884.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-460. https://doi.org/10.1016/j.jhep.2018.03.024.
Caraceni P, Pavesi M, Baldassarre M, Bernardi M, Arroyo V. The use of human albumin in patients with cirrhosis: A European survey. Expert Rev Gastroenterol Hepatol 2018;12:625-632. https://doi.org/10.1080/17474124.2018.1460203.
China L, Freemantle N, Forrest E, Kallis Y, Ryder SD, Wright G, et al. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. N Engl J Med 2021;384:808-817. https://doi.org/10.1056/NEJMoa2022166.
Walayat S, Martin D, Patel J, Ahmed U, N Asghar M, Pai AU, et al. Role of albumin in cirrhosis: from a hospitalist's perspective. J Community Hosp Intern Med Perspect 2017;7:8-14. https://doi.org/10.1080/20009666.2017.1302704.
Kao HW, Rakov NE, Savage E, Reynolds TB. The effect of large volume paracentesis on plasma volume--A cause of hypovolemia? Hepatology 1985;5:403-407. https://doi.org/10.1002/hep.1840050310.
Ginès P, Titó L, Arroyo V, Planas R, Panés J, Viver J, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988;94:1493-1502. https://doi.org/10.1016/0016-5085(88)90691-9.
Tandon P, Tsuyuki RT, Mitchell L, Hoskinson M, Ma MM, Wong WW, et al. The effect of 1 month of therapy with midodrine, octreotide-LAR and albumin in refractory ascites: A pilot study. Liver Int 2009;29:169-174. https://doi.org/10.1111/j.1478-3231.2008.01778.
Bari K, Miñano C, Shea M, Inayat IB, Hashem HJ, Gilles H, et al. The combination of octreotide and midodrine is not superior to albumin in preventing recurrence of ascites after large-volume paracentesis. Clin Gastroenterol Hepatol 2012;10:1169-1175. https://doi.org/10.1016/j.cgh.2012.06.027.
Bernardi M, Caraceni P, Navickis J, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: A meta-analysis of randomized trials. Hepatology 2012;55:1172-1181. https://doi.org/10.1002/hep.24786.
Ginès A, Fernández-Esparrach G, Monescillo A, Vila C, Domènech E, Abecasis R, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002-1010. https://doi.org/10.1016/s0016-5085(96)70068-9.
Arora V, Vijayaraghavan R, Maiwall R, Sahney A, Thomas SS, Ali R, et al. Paracentesis-induced circulatory dysfunction with modest-volume paracentesis is partly ameliorated by albumin infusion in acute-on-chronic liver failure. Hepatology 2020;72:1043-1055. https://doi.org/10.1002/hep.31071.
Karvellas CJ, Bajaj JS, Kamath PS, Napolitano L, O'Leary JG, Solà E, et al. AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis. Hepatology 2024;79:1463-1502. https://doi.org/10.1097/HEP.0000000000000671.
Maiwall R, Singh SP, Angeli P, Moreau R, Krag A, Singh V, et al. APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure. Hepatol Int 2024;18:833-869. https://doi.org/10.1007/s12072-024-10650-0.
Alessandria C, Elia C, Mezzabotta L, Risso A, Andrealli A, Spandre M, et al. Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: Standard vs half albumin doses. A prospective, randomized, unblinded pilot study. Dig Liver Dis 2011;43:881-886. https://doi.org/10.1016/j.dld.2011.06.001.
Markley JD, Bajaj JS. Rethinking antibiotic prophylaxis for spontaneous bacterial peritonitis in patients with cirrhosis: First, do no harm. Clin Infect Dis 2025;80:710-714. https://doi.org/10.1093/cid/ciaf047.
Nadim MK, Garcia-Tsao G. Acute kidney injury in patients with cirrhosis. N Engl J Med 2023; 388:733-745. https://doi.org/10.1056/NEJMra2215289.
Chen TA, Tsao YC, Chen A, Lo GH, Lin CK, Yu HC, et al. Effect of intravenous albumin on endotoxin removal, cytokines, and nitric oxide production in patients with cirrhosis and spontaneous bacterial peritonitis. Scand J Gastroenterol 2009;44:619-625. https://doi.org/10.1080/00365520902719273.
Fernández J, Navasa M, Garcia-Pagan JC, G-Abraldes J, Jiménez W, Bosch J, et al. Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis. J Hepatol 2004;41:384-390. https://doi.org/10.1016/j.jhep.2004.05.009.
Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-409. https://doi.org/10.1056/NEJM199908053410603.
Batool S, Waheed MD, Vuthaluru K, Jaffar T, Garlapati SKP, Bseiso O, et al. Efficacy of intravenous albumin for spontaneous bacterial peritonitis infection among patients with cirrhosis: A meta-analysis of randomized control trials. Cureus 2022;14:e33124. https://doi.org/10.7759/cureus.33124.
Kar PS, Venishetty S, Laroia ST, Jindal A, Maiwall R, Sood AK, et al. Tolerance of standard dose albumin infused over 6 hrs for treatment of spontaneous bacterial peritonitis-A randomized controlled trial. Indian J Gastroenterol 2023;42:505-516. https://doi.org/10.1007/s12664-023-01389-x.
Cullaro G, Kanduri SR, Q Vélez JC. Acute kidney injury in patients with liver disease. Clin J Am Soc Nephrol 2022;17:1674-1684. https://doi.org/10.2215/CJN.03040322.
Nadim MK, Kellum JA, Forni L, Francoz C, Asrani SK, Ostermann M, et al. Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting. J Hepatol 2024;81:163-183. https://doi.org/10.1016/j.jhep.2024.03.031.
Patidar KR, Belcher JM, Regner KR, St Hillien SA, Simonetto DA, Asrani SK, et al. Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US. J Hepatol 2023;79:1408-1417. https://doi.org/10.1016/j.jhep.2023.07.010.
Desai AP, Knapp SM, Orman ES, Ghabril MS, Nephew LD, Anderson M, et al. Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis - a US population-based study. J Hepatol 2020;73:1092-1099. https://doi.org/10.1016/j.jhep.2020.04.043.
Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites. J Hepatol 2015;62:968-74. https://doi.org/10.1016/j.jhep.2014.12.029.
Ma AT, Solé C, Juanola A, Escudé L, Napoleone L, Avitabile E, et al. Prospective validation of the EASL management algorithm for acute kidney injury in cirrhosis. J Hepatol 2024;81:441-450. https://doi.org/10.1016/j.jhep.2024.03.006.
Ma AT, Juanola A, Solé C, Ginés P. Shortening the albumin challenge from 48 to 24 hours may lead to overdiagnosis of hepatorenal syndrome-acute kidney injury and overtreatment with terlipressin. J Hepatol 2025;82:e98-e99. https://doi.org/10.1016/j.jhep.2024.07.015.
Schleicher EM, Karbannek H, Weinmann-Menke J, Galle PR, Stallmach A, Gairing S, et al. Effect of albumin treatment duration on response rates and outcomes in patients with cirrhosis and acute kidney injury. J Hepatol 2025;83:682-691. https://doi.org/10.1016/j.jhep.2025.03.008.
Angeli P, Labenz C, Piano S, Juanola A, Krag A, Caraceni P, et al. Albumin infusion in hepatorenal syndrome-acute kidney injury: New evidence challenges recent consensus. J Hepatol 2025;83:800-802. https://doi.org/10.1016/j.jhep.2025.04.011.
Guevara M, Ginès P, Fernández-Esparrach G, Sort P, Salmerón JM, et al. Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion. Hepatology 1998;27:35-41. https://doi.org/10.1002/hep.510270107.
Ortega R, Ginès P, Uriz J, Cárdenas A, Calahorra B, De Las Heras D, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 2002;36:941-948. https://doi.org/10.1053/jhep.2002.35819.
Martín-Llahí M, Pépin MN, Guevara M, Díaz F, Torre A, Monescillo A, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: A randomized study. Gastroenterology 2008;134:1352-1359. https://doi.org/10.1053/j.gastro.2008.02.024.
Allegretti AS, Israelsen M, Krag A, Jovani M, Goldin AH, Schulman AR, et al. Terlipressin versus placebo or no intervention for people with cirrhosis and hepatorenal syndrome. Cochrane Database Syst Rev 2017;6:CD005162. https://doi.org/10.1002/14651858.CD005162.pub4.
Wong F, Pappas SC, Curry MP, Reddy KR, Rubin RA, Porayko MK, et al. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome. N Engl J Med 2021;384:818-828. https://doi.org/10.1056/NEJMoa2008290.
AlSowaiegh RM, Yusuf KA, Freemantle N, O'Brien A. A systematic review and meta-analysis of the use of human albumin solution for treating the complications of liver cirrhosis. Hepatol Commun 2026;10:e0875. https://doi.org/10.1097/HC9.0000000000000875.
Guevara M, Terra C, Nazar A, Solà E, Fernández J, Pavesi M, et al. Albumin for bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. A randomized, controlled study. J Hepatol 2012;57:759-765. https://doi.org/10.1016/j.jhep.2012.06.013.
Thévenot T, Bureau C, Oberti F, Anty R, Louvet A, Plessier A, et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial. J Hepatol 2015;62: 822-830. https://doi.org/10.1016/j.jhep.2014.11.017.
Fernández J, Angeli P, Trebicka J, Merli M, Gustot T, Alessandria C, et al. efficacy of albumin treatment for patients with cirrhosis and infections unrelated to spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2020;18:963-973.e14. https://doi.org/10.1016/j.cgh.2019.07.055.
Philips CA, Maiwall R, Sharma MK, Jindal A, Choudhury AK, Kumar G, et al. Comparison of 5% human albumin and normal saline for fluid resuscitation in sepsis induced hypotension among patients with cirrhosis (FRISC study): a randomized controlled trial. Hepatol Int 2021;15:983-994. https://doi.org/10.1007/s12072-021-10164-z.
Maiwall R, Kumar A, Pasupuleti SSR, Hidam AK, Tevethia H, Kumar G, et al. A randomized-controlled trial comparing 20% albumin to plasmalyte in patients with cirrhosis and sepsis-induced hypotension [ALPS trial]. J Hepatol 2022;77:670-682. https://doi.org/10.1016/j.jhep.2022.03.043.
Bajaj JS, Tandon P, OʼLeary JG, Biggins SW, Wong F, Kamath PS, et al. The impact of albumin use on resolution of hyponatremia in hospitalized patients with cirrhosis. Am J Gastroenterol 2018;113:1339. https://doi.org/10.1038/s41395-018-0119-3.
Simón-Talero M, García-Martínez R, Torrens M, Augustin S, Gómez S, Pereira G, et al. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol 2013;59:1184-1192. https://doi.org/10.1016/j.jhep.2013.07.020.
Riggio O, Nardelli S, Pasquale C, Pentassuglio I, Gioia S, Onori E, et al. No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Metab Brain Dis 2016;31:1275-1281. https://doi.org/10.1007/s11011-015-9713-x.
Ventura-Cots M, Simón-Talero M, Poca M, Ariza X, Masnou H, Sanchez J, et al. Effects of albumin on survival after a hepatic encephalopathy episode: Randomized double-blind trial and meta-analysis. J Clin Med 2021;10:4885. https://doi.org/10.3390/jcm10214885.
Fagan A, Gavis EA, Gallagher ML, Mousel T, Davis B, Puri P, et al. A double-blind randomized placebo-controlled trial of albumin in outpatients with hepatic encephalopathy: HEAL study. J Hepatol 2023;78:312-321. https://doi.org/10.1016/j.jhep.2022.09.009.
China L, Freemantle N, Forrest E, Kallis Y, Ryder SD, Wright G, et al. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. N Engl J Med 2021;384:808-817. https://doi.org10.1056/NEJMoa2022166.
Gentilini P, Casini-Raggi V, Di Fiore G, Romanelli RG, Buzzelli G, Pinzani M, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol 1999;30:639-645. https://doi.org/10.1016/s0168-8278(99)80194-9.
Romanelli RG, La Villa G, Barletta G, Vizzutti F, Lanini F, Arena U, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial. World J Gastroenterol 2006;12:1403-1407. https://doi.org/10.3748/wjgv12.i9.1403.
Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): An open-label randomised trial. Lancet 2018;391:2417-2429. https://doi.org/10.1016/S0140-6736(18)30840-7.
Solà E, Solé C, Simón-Talero M, Martín-Llahí M, Castellote J, Garcia-Martínez R, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation. A randomized placebo-controlled trial. J Hepatol 2018;69:1250-1259. https://doi.org/10.1016/j.jhep.2018.08.006.
Di Pascoli M, Fasolato S, Piano S, Bolognesi M, Angeli P. Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites. Liver Int 2019;39:98-105. https://doi.org/10.1111/liv.13968.
O’Leary JG, Perricone G, Laleman W, Milovanovic T, Torres M, Campins N, et al. LBO-003 Efficacy and safety of long-term human albumin therapy in cirrhotic patients with acute decompensation and ascites: Topline results of the PRECIOSA trial. J Hepatol 2025;82:S10.
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