{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:55:37Z","timestamp":1793310937143,"version":"4.5.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Protein loading appears nephroprotective; thus, continuous hyperoncotic albumin infusion may impact AKI following high-risk cardiac surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effect of postoperative 20% albumin infusion compared with usual care on the occurrence of AKI in high-risk cardiac surgery patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was an investigator-initiated randomized multicenter open-label pragmatic clinical trial. Participants were stratified by site and estimated glomerular filtration rate (eGFR) above and below 60 mL\/min\/1.73 m<jats:sup>2<\/jats:sup>. The study was conducted at 7 cardiac centers in Australia and Italy between July 2019 and August 2024. Patients undergoing on-pump cardiac surgery with a preoperative eGFR of greater than 15 mL\/min\/1.73 m<jats:sup>2<\/jats:sup> and less than 60 mL\/min\/1.73 m<jats:sup>2<\/jats:sup> or undergoing a combined cardiac surgical procedure or major aortic surgery were included, excluding those who were in intensive care for longer than 6 hours following the index surgery, had a serum albumin level less than 20 g\/L, were dialysis dependent, had a previous kidney transplant, were receiving extracorporeal life support or ventricular assist device, or had an objection to receiving albumin or blood products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Participants were randomized 1:1 within 6 hours after surgery to receive a 300-mL infusion of 20% albumin over 15 hours or usual care, as per clinician discretion. All patients received volume resuscitation and hemodynamic treatment according to participating centers\u2019 protocols.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was stage 1-3 AKI according to the creatinine-based Kidney Disease Improving Global Outcomes definition. The main secondary outcomes included major adverse kidney events and mortality at hospital discharge or day 28 following randomization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The primary analysis included 307 patients randomized to the 20% albumin group and 304 to usual care. The mean (SD) age was 69 (10.8) years, and 281 patients (45.8%) had an eGFR less than 60 mL\/min\/1.73 m<jats:sup>2<\/jats:sup>. The median (IQR) European System for Cardiac Operative Risk Evaluation score-II was 3.23 (1.91-5.30). AKI occurred in 150 of 307 patients in the albumin group (48.9%) vs 132 of 304 in usual care (43.4%) (unadjusted relative risk, 1.13; 95% CI, 0.95-1.34; <jats:italic>P<\/jats:italic>\u2009=\u2009.18; strata-adjusted relative risk, 1.12; 95% CI, 1.04-1.21; <jats:italic>P<\/jats:italic>\u2009=\u2009.003). This effect was more pronounced in patients with an eGFR of &amp;amp;lt;60 mL\/min\/1.73 m<jats:sup>2<\/jats:sup> (adjusted relative risk, 1.14; 95% CI; 1.07-1.22; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). There were more blood transfusions given in the albumin group (116 [37.8%] vs 91 [29.9%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.04) but no other significant differences in secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study of cardiac surgery patients at high risk of AKI, an infusion of 20% albumin increased the risk of AKI. These findings do not support the routine use of hyperoncotic albumin infusion in patients undergoing high-risk cardiac surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>Anzctr.org.au Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=378383&amp;amp;amp;showOriginal=true&amp;amp;amp;isReview=true\">ACTRN12619001355167<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2025.1683","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T11:01:08Z","timestamp":1749639668000},"page":"835","source":"Crossref","is-referenced-by-count":34,"title":["Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients"],"prefix":"10.1001","volume":"160","author":[{"given":"Yahya","family":"Shehabi","sequence":"first","affiliation":[{"name":"Monash Health 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