Review article: albumin for circulatory support in patients with cirrhosis

SUMMARY Renal function abnormalities and ascites in cirrhosis arethe final consequence of a circulatory dysfunctioncharacterized by marked splanchnic arterial vasodila-tion. This causes a reduction in effective arterial bloodvolume and the homoeostatic activation of vasocon-strictor and sodium-retaining systems. Albumin is veryeffective in preventing renal failure associated withlarge-volume paracentesis and spontaneous bacterialperitonitis, conditions that are known to cause animpairment of circulatory function in patients withcirrhosis and ascites. Moreover, albumin administrationimproves survival in patients with spontaneous bacter-ial peritonitis. In patients with hepatorenal syndromethe administration of vasoconstrictor drugs in combina-tion with albumin improves circulatory and renalfunction markedly and survival slightly. By contrast,the administration of albumin without vasoconstrictorshas marginal or no effects on renal function in thissetting. INTRODUCTION The course of patients with cirrhosis is frequentlycomplicated by an abnormal regulation of body fluidhomoeostasis, which results in the accumulation of anincreased amount of fluid in the extracellular space,especially in the peritoneal cavity as ascites.