Efficacy and safety of human albumin solutions in adult patients undergoing cardiac surgery

Introduction. Human albumin (HA) solution is commonly used in cardiac surgery for hypovolemia correction, hemodynamic stabilization, and as a component of perfusion media. Despite its widespread use, the efficacy and safety of HA in cardiac surgery patients remain debated. Existing evidence is conflicting: some studies suggest potential benefits for hemodynamic control and renal function, while others show no significant advantage over crystalloids or synthetic colloids regarding key outcomes such as mortality and complication rates. The lack of unified clinical guidelines or algorithms for HA administration in the perioperative period, coupled with its high cost, underscores the need for a systematic review of current evidence to define clear and justified indications for its use in this specific patient population.

The objective was to review the literature on the effectiveness and safety of using HA solutions in adult cardiac surgery patients

Materials and methods. Based on the analysis of literature in the PubMed, Cochrane Library, eLibrary, Google Scholar databases, publications were selected with search restrictions on the following parameters: «people», «adults», «efficacy», «safety», «replenishment of CBV», «hypoalbuminemia », «intensive care», «surgical intervention», «cardiac surgery», «mortality», «survival».

Results. According to the literature analysis, the use of HA solutions in cardiac surgery patients in the situation of hypovolemia correction and hemodynamic stabilization is justified. Preference should be given to isooncotic HA solution (4–5%). The administration of HA solution does not affect the frequency of postoperative complications, mortality, length of stay in the intensive care unit and hospital.

Conclusions. The use of HA solutions in cardiac surgery patients requires an individual approach, assessment of the clinical condition and potential benefits of its physiological effects in certain clinical scenarios, however, additional randomized clinical studies comparing albumin 5% and albumin 20% in this population are needed for final conclusions.

1. The State Register of Medicines, Moscow, 2025, URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=043b35e0-431c-4f97-bbe5-b226cb18c883&t = (accessed: 06/09/2025). (In Russ.).

2. Gosh S., Eremenko A. A. Guidelines for intravenous infusions. Moscow: GEOTAR-Media, 2025. 368 p. URL: https://www.geotar.ru/lots/NF0029883.html (accessed: 06/09/2025).

3. Unified Register of Registered Medicines of the Eurasian the Economic Union, Moscow, 2025, URL: https://lk.regmed.ru/Register/EAEU_SmPC (accessed: 06/09/2025). (In Russ.).

4. Clinical recommendations. Thermal and chemical burns. Sunburns. Burns of the respiratory tract, Moscow, 2024, URL: https://cr.minzdrav.gov.ru/preview-cr/687_3 (accessed: 06/09/2025). (In Russ.).

5. Clinical recommendations. Sepsis (in adults), Moscow, 2024, URL: https://cr.minzdrav.gov.ru/preview-cr/898_1 (accessed: 06/09/2025). (In Russ.).

6. Sectional Guidelines for therapy with blood components and plasma derivatives: chapter 5 human Benefit M. Guidelines for intravenous Albumin administration at stanford health care [Электронный ресурс]. – 2017. URL: https://stanfordhealthcare.org/content/dam/SHC/health-care-professionals/medical-staff/medstaff-weekly/20170315-guidelines-for-intravenous-albumin-administration.pdf (дата обращения: 09.06.2025).

7. Bihari S., Wiersema U. F., Perry R. et al. Efficacy and safety of 20% albumin fluid loading in healthy subjects: a comparison of four resuscitation fluids // Journal of Applied Physiology. – 2019. – Vol. 126, № 6. – P. 1646–1660. http://doi.org/10.1152/japplphysiol.01058.2018.

8. Board S. A. Cross-Albumin-revised // Transfusion Medicine and Hemotherapy. – 2016. – Vol. 43. – P. 223–232. http://doi.org/10.1159/000446043.

9. Boldt J., Brosch Ch., Röhm K. et al. Is albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function? // Anesthesia & Analgesia. – 2008. – Vol. 107, № 5. – P. 1496–1503. http://doi.org/10.1213/ane.0b013e31818370b2.

10. Finfer S., Bellomo R., McEvoy S. et al. Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study // BMJ. – 2006. – Vol. 333, № 7577. – P. 1044. http://doi.org/10.1136/bmj.38985.398704.7C.

11. Fink R. J., Young A., Yanez N. D. et al. Cohort study of albumin versus lactated Ringer’s for postoperative cardiac surgery fluid resuscitation in the intensive care unit // Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. – 2018. – Vol. 38, № 12. – P. 1241–1249. http://doi.org/10.1002/phar.2195.

12. Frenette A. J., Bouchard J., Bernier P. et al. Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis // Critical Care. – 2014. – Vol. 18. – P. 1–11. http://doi.org/10.1186/s13054-014-0602-1.

13. von Hoegen I., Waller C. Safety of human albumin based on spontaneously reported serious adverse events // Critical Care Medicine. – 2001. – Vol. 29, № 5. – P. 994–996. http://doi.org/10.1097/00003246-200105000-00021.

14. Khademi S., Heirany F., Jouybar R. et al. Effect of albumin usage during cardiopulmonary bypass on postoperative acute kidney injury in cardiac surgery patients: A historical cohort study // Annals of Cardiac Anaesthesia. – 2023. – Vol. 26, № 3. – P. 288–294. http://doi.org/10.4103/aca.aca_84_22.

15. Kingeter A. J., Raghunathan K., Munson S. H. et al. Association between albumin administration and survival in cardiac surgery: a retrospective cohort study // Canadian Journal of Anesthesia. – 2018. – Vol. 65, № 11. – P. 1218–1227. http://doi.org/10.1007/s12630-018-1181-4.

16. Kuitunen A., Suojaranta-Ylinen R., Kukkonen S. et al. A comparison of the haemodynamic effects of 4% succinylated gelatin, 6% hydroxyethyl starch (200/0.5) and 4% human albumin after cardiac surgery // Scandinavian Journal of Surgery. – 2007. – Vol. 96, № 1. – P. 72–78. http://doi.org/10.1177/145749690709600114.

17. Lee E. H., Kim W.-J., Kim J.-Y. et al. Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery with a preoperative albumin level of less than 4.0 g/dl // Survey of Anesthesiology. – 2016. – Vol. 60, № 6. – P. 227–228. http://doi.org/10.1097/ALN.0000000000001051.

18. Lu H., Zhang Y., Liu P. Identifying new safety risk of human serum albumin: a retrospective study of real-world data // Frontiers in Pharmacology. – 2024. – Vol. 15. – P. 1319900. http://doi.org/10.3389/fphar.2024.1319900.

19. Matebele M. P., Ramanan M., Thompson K. et al. Albumin use after cardiac surgery // Critical Care Explorations. – 2020. – Vol. 2, № 7. – P. e0164. http://doi.org/10.1097/CCE.0000000000000164.

20. Matsumoto T. K., Makino S., Matsumoto M. et al. Evidence-based guidelines for the use of Albumin products Japan Society of Transfusion Medicine and Cell Therapy // Japanese Journal of Transfusion and Cell Therapy. – 2017. – Vol. 63, № 563. – P. 5. http://doi.org/10.3925/jjtc.63.641.

21. Moman R. N., Gupta N., Varacallo M. Physiology, albumin. – 2017. – URL: https://www.ncbi.nlm.nih.gov/books/NBK459198/ (дата обращения: 09.06.2025).

22. Nicholson J. P., Wolmarans M. R., Park G. R. The role of albumin in critical illness // British Journal of Anaesthesia. – 2000. – Vol. 85, № 4. – P. 599–610. http://doi.org/10.1093/bja/85.4.599.

23. Rasmussen K. C., Hоjskov M., Johansson P. I. Impact of albumin on coagulation competence and hemorrhage during major surgery: a randomized controlled trial // Medicine. – 2016. – Vol. 95, № 9. – P. e2720. http://doi.org/10.1097/MD.0000000000002720.

24. Roberts I., Bunn F., Li Wan Po A. et al. Human albumin solution for resuscitation and volume expansion in critically ill patients // Cochrane Database of Systematic Reviews. – 2011. – № 11. http://doi.org/10.1002/14651858.CD001208.

25. Sang B. H., Bang J.-Y., Song J.-G. et al. Hypoalbuminemia within two postoperative days is an independent risk factor for acute kidney injury following living donor liver transplantation: a propensity score analysis of 998 consecutive patients // Critical Care Medicine. – 2015. – Vol. 43, № 12. – P. 2552–2561. http://doi.org/10.1097/CCM.0000000000001279.

26. Scott D. A., Hore P. J., Cannata J. et al. A comparison of albumin, polygeline and crystalloid priming solutions for cardiopulmonary bypass in patients having coronary artery bypass graft surgery // Perfusion. – 1995. – Vol. 10, № 6. – P. 415–424. http://doi.org/10.1177/026765919501000605.

27. Sedrakyan A., Gondek K., Paltiel D. et al. Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery // Chest. – 2003. – Vol. 123, № 6. – P. 1853–1857. http://doi.org/10.1378/chest.123.6.1853.

28. Skhirtladze K., Base E. M., Lassnigg A. et al. Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer’s lactate on blood loss and coagulation after cardiac surgery // British Journal of Anaesthesia. – 2014. – Vol. 112, № 2. – P. 255–264. http://doi.org/10.1093/bja/aet348.

29. Skubas N. J., Callum J., Bathla A. et al. Intravenous albumin in cardiac and vascular surgery: a systematic review and meta-analysis // British Journal of Anaesthesia. – 2024. – Vol. 132, № 2. – P. 237–250. http://doi.org/10.1016/j.bja.2023.11.009.

30. Tanzi M., Gardner M., Megellas M. et al. Evaluation of the appropriate use of albumin in adult and pediatric patients // American journal of health-system pharmacy. – 2003. – Vol. 60, № 13. – P. 1330–1335. http://doi.org/10.1093/ajhp/60.13.1330.

31. Vermeulen L. C., Ratko T. A., Erstad B. L. et al. A paradigm for consensus: the University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions // Archives of internal medicine. – 1995. – Vol. 155, № 4. – P. 373–379. http://doi.org/10.1001/archinte.155.4.373.

32. Vincent J. L., Dubois M.-J., Navickiset R. J. al. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials // Annals of surgery. – 2003. – Vol. 237, № 3. – P. 319–334. http://doi.org/10.1097/01.SLA.0000055547.93484.87.

33. Vincent J. L., Navickis R. J., Wilkes M. M. Morbidity in hospitalized patients receiving human albumin: a meta-analysis of randomized, controlled trials // Critical care medicine. – 2004. – Т. 32. – № . 10. – С. 2029-2038. http://doi.org/10.1097/01.CCM.0000142574.00425.E9.

34. Wang T., Wang J., Zhang M. et al. Effects of albumin and crystalloid priming strategies on red blood cell transfusions in on-pump cardiac surgery: a network meta-analysis // BMC anesthesiology. – 2024. – Vol. 24, № 1. – P. 26. http://doi.org/10.1186/s12871-024-02414-y.

35. Wiedermann C. J., Wiedermann W., Joannidis M. Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies // Intensive care medicine. – 2010. – Vol. 36. – P. 1657–1665. http://doi.org/10.1007/s00134-010-1928-z.

36. Wiedermann C. J., Dunzendorfer S., Gaioni L. U. et al. Hyperoncotic colloids and acute kidney injury: a meta-analysis of randomized trials // Critical Care. – 2010. – Vol. 14. – P. 1–9. http://doi.org/10.1186/cc9308.

37. Wigmore G. J., Anstey J. R., St John A. et al. 20% human albumin solution fluid bolus administration therapy in patients after cardiac surgery (the HAS FLAIR study) // Journal of cardiothoracic and vascular anesthesia. – 2019. – Vol. 33, № 11. – P. 2920–2927. http://doi.org/10.1053/j.jvca.2019.03.049.

38. Wilkes M. M., Navickis R. J., Sibbald W. J. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding // The Annals of thoracic surgery. – 2001. – Vol. 72, № 2. – P. 527–533. http://doi.org/10.1016/S0003-4975(01)02745-X.

39. Wahba A., Kunst G., De Somer F. et al. Guidelines on cardiopulmonary bypass in adult cardiac surgery. EACTS/EACTAIC/EBCP // Br J Anaesth. – 2025. – Vol. 134, № 4. – P. 917–1008. http://doi.org/10.1016/j.bja.2025.01.015.