Albumin infusion in Hepatorenal Syndrome-Acute Kidney Injury: new evidence challenges recent consensus.

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2025-04-17 DOI:10.1016/j.jhep.2025.04.011

Paolo Angeli, Christian Labenz, Salvatore Piano, Adrià Juanola, Aleksander Krag, Paolo Caraceni, Jonel Trebicka, Rakhi Maiwall, Virendra Singh, Elisa Pose, Carmine Gambino, Sebastian Marciano, Peter R. Galle, Shiv K. Sarin, Pere Ginès, Patrick S. Kamath

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引用次数: 0

Abstract

Section snippets

The new evidence in the management of HRS-AKI in patients with cirrhosis

The conclusions of the ADQI and ICA Joint Multidisciplinary Consensus Meeting were published in the Journal of Hepatology in July 2024 (2).Subsequently, a prospective observational study was published in the same Journal in September 2024 analyzing the effectiveness of the algorithm proposed by the EASL CPGs in the management of AKI in patients with cirrhosis and a letter as explanatory corollary by the Barcelona research team led by Pere Ginès 3, 4. The main content of these papers can be

Discussion

To rectify any misunderstanding, it is accepted that at the time of developing the position paper of the ADQI and ICA the results of this research group have not yet been published. This being said, the issue of volume expansion in the management of AKI should be discussed. Without any doubt, the need for assessing the patient volume status and thus the real need for volume replacement, and the need to standardize methods to assess volume status and monitor the response to volume replacement is

Conclusions

The application of the EASL AKI algorithm, derived from the previous statements proposed by the ICA, is associated with very good response rates and does not significantly delay initiation of therapy with terlipressin. The use of 48-hour albumin infusion and the use of the old diagnostic criteria to differentiate HRS-AKI and ATN-AKI are both essential components of the algorithm. There is need for studies addressing the important questions on the dose and duration of albumin treatment to

Authors’ contribution

Conceptualization (PA, SP, PC, PG, PK), drafting of the manuscript (PA), revision for important intellectual content and approval of the final manuscript (all authors).

Funding

No specific funding supported this paper.

Declaration of Competing Interest

PA received grant/research support from Grifols and CSL Behring; held a patent with Biovie; served as consulting for Sequana Medical and BioMarin. CL received speaker fees from CSL Behring. SP received grant/research support from Italian Minstry of Health, European Union; speaker fees from Ferring, Grifols, MEDSCAPE; served as consulting for Boehringer Ingelheim. AK received grant/research support from European Union, Novo Nordisk Foundation, AstraZeneca; speaker fees from Norgine, Siemens,

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白蛋白输注在肝肾综合征-急性肾损伤：新证据挑战最近的共识。

ADQI和ICA联合多学科共识会议的结论于2024年7月发表在《国际肝病杂志》（Journal of Hepatology）上(2)。2024年9月发表在同一杂志上的一项前瞻性观察性研究分析了EASL CPGs提出的算法在肝硬化患者AKI管理中的有效性，以及由Pere gin领导的巴塞罗那研究小组的一篇解释结论的信。为了纠正任何误解，可以接受的是，在制定ADQI和ICA立场文件时，本课题组的结果尚未发表。话虽如此，应该讨论AKI管理中的体积扩大问题。毫无疑问，需要评估患者容量状态，从而评估容量替代的真实需求，以及需要标准化评估容量状态和监测容量替代反应的方法。结论：EASL AKI算法的应用源自ICA先前提出的声明，与非常好的缓解率相关，并且不会显著延迟特利加压素治疗的开始。使用48小时白蛋白输注和使用旧的诊断标准来区分hr - aki和ATN-AKI都是该算法的重要组成部分。需要对白蛋白治疗剂量和持续时间的重要问题进行研究，包括概念化（PA， SP， PC， PG， PK），草稿起草（PA），重要知识内容的修改和最终稿的批准（所有作者）。没有特定的资金支持本文。竞争利益声明pa获得Grifols和CSL Behring的资助/研究支持；拥有百维专利；曾担任Sequana Medical和BioMarin的顾问。CL收到了CSL Behring的演讲费。SP获得欧洲联盟意大利卫生部的赠款/研究支助；Ferring, Grifols， MEDSCAPE的讲话费；曾担任勃林格殷格翰公司的顾问。AK获得了欧盟、诺和诺德基金会、阿斯利康的资助/研究支持；诺津、西门子、

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来源期刊

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.