{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:39:22Z","timestamp":1786653562628,"version":"build-2736575974"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The effect of hyperoncotic (20%\u201325%) human albumin on cardiac-surgery\u2013associated acute kidney injury (CS-AKI) is uncertain. This study evaluated whether intraoperative or postoperative administration of 20%\u201325% albumin influences the risk of CS-AKI compared with crystalloids or iso-oncotic (4%\u20135%) albumin. Systematic review and meta-analysis of randomized controlled trials (RCTs) and risk-adjusted cohort studies were conducted. Risk ratios (RRs) were pooled using random-effects models. Literature search of PubMed, Embase (Ovid), and Cochrane CENTRAL was carried out from January 1, 1995, to July 17, 2025. Adults undergoing on-pump CS. Four eligible studies\u2014two RCTs and two cohort studies, encompassing 6651 patients\u2014were included. About 20%\u201325% of human albumin was administered either intraoperatively or within 24 h postoperatively. Comparators were crystalloids or 4%\u20135% albumin. The primary outcome was the incidence of any-stage AKI within 7 days of surgery. Pooled analysis showed 20%\u201325% albumin increased the risk of CS-AKI (RR 1.10, 95% confidence interval [CI] 1.05\u20131.16; I\u00b2 =0%). Restriction to RCTs yielded a similar result (RR 1.12, 95% CI 1.04\u20131.20). The increased risk was consistent for both intraoperative (RR 1.09) and postoperative (RR 1.12) administration, but the interaction between infusion timing was non-significant (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.59). Infusion of 20%\u201325% albumin is associated with a modest but consistent increase in postoperative AKI, independent of infusion timing from intraoperative to postoperative within 24 h. Until adequately powered trials resolve the remaining imprecision, routine perioperative administration of hyperoncotic albumin should be approached with caution.\n                  <\/jats:p>","DOI":"10.4103\/aca.aca_345_25","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:01:24Z","timestamp":1777489284000},"page":"325-334","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Albumin Concentration and Timing on Acute Kidney Injury After Adult Cardiac Surgery: A Systematic Review and Meta-analysis"],"prefix":"10.4103","volume":"29","author":[{"given":"Toru","family":"Abo","sequence":"first","affiliation":[{"name":"Department of Surgery, National Center for Global Health and Medicine\/Japan Institute for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Umibe","sequence":"additional","affiliation":[{"name":"Department of Surgery, National Center for Global Health and Medicine\/Japan Institute for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Center for Global Health and Medicine\/Japan Institute for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyasu","family":"Tongu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Center for Global Health and Medicine\/Japan Institute for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensei","family":"Oya","sequence":"additional","affiliation":[{"name":"Department of Surgery, National Center for Global Health and Medicine\/Japan Institute for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"R1-20260803","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s13054-016-1352-z","article-title":"Acute kidney injury following cardiac surgery: Current understanding and future directions","volume":"20","author":"O'Neal","year":"2016","journal-title":"Crit Care"},{"issue":"(1 Suppl)","key":"R2-20260803","first-page":"I409","article-title":"Perioperative increases in serum creatinine are associated with higher mortality after cardiac surgery","volume":"114","author":"Brown","year":"2006","journal-title":"Circulation"},{"key":"R3-20260803","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s40620-016-0351-0","article-title":"The duration of acute kidney injury after cardiac surgery increases the risk of long-term chronic kidney disease","volume":"30","author":"Palomba","year":"2017","journal-title":"J Nephrol"},{"key":"R4-20260803","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1681\/ASN.2004040331","article-title":"A clinical score to predict acute renal failure after cardiac surgery","volume":"16","author":"Thakar","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"R5-20260803","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1046\/j.1365-2044.1998.00438.x","article-title":"Serum albumin: Touchstone or totem?","volume":"53","author":"Margarson","year":"1998","journal-title":"Anaesthesia"},{"key":"R6-20260803","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1001\/jama.2022.10461","article-title":"Effect of 4% albumin solution versus ringer acetate on major adverse events in patients undergoing cardiac surgery with cardiopulmonary bypass: A randomized clinical trial","volume":"328","author":"Pesonen","year":"2022","journal-title":"JAMA"},{"key":"R7-20260803","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1056\/NEJMoa040232","article-title":"A comparison of albumin and saline for fluid resuscitation in the intensive care unit","volume":"350","author":"Finfer","year":"2004","journal-title":"N Engl J Med"},{"key":"R8-20260803","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1056\/NEJMoa1305727","article-title":"Albumin replacement in patients with severe sepsis or septic shock","volume":"370","author":"Caironi","year":"2014","journal-title":"N Engl J Med"},{"key":"R9-20260803","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.bja.2024.07.038","article-title":"Perioperative fluid management: Evidence-based consensus recommendations (POQI\/ESAIC\/EACTAIC)","volume":"133","author":"Ostermann","year":"2024","journal-title":"Br J Anaesth"},{"key":"R10-20260803","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1007\/s12630-021-01991-7","article-title":"Albumin in adult cardiac surgery: A narrative review","volume":"68","author":"Hanley","year":"2021","journal-title":"Can J Anesth"},{"key":"R11-20260803","doi-asserted-by":"crossref","first-page":"5919","DOI":"10.3390\/jcm12185919","article-title":"Human albumin infusion in critically ill and perioperative patients: Narrative rapid review of meta-analyses from the last five years","volume":"12","author":"Wiedermann","year":"2023","journal-title":"J Clin Med"},{"key":"R12-20260803","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1097\/ALN.0000000000001051","article-title":"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","volume":"124","author":"Lee","year":"2016","journal-title":"Anesthesiology"},{"key":"R13-20260803","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/2110-5820-1-13","article-title":"Understanding urine output in critically ill patients","volume":"1","author":"Legrand","year":"2011","journal-title":"Ann Intensive Care"},{"key":"R14-20260803","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/ndt\/gfad215","article-title":"Tubular toxicity of proteinuria and the progression of chronic kidney disease","volume":"39","author":"Makhammajanov","year":"2024","journal-title":"Nephrol Dial Transplant"},{"key":"R15-20260803","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.bja.2023.11.009","article-title":"Intravenous albumin in cardiac and major vascular surgery: A systematic review and meta-analysis","volume":"132","author":"Skubas","year":"2024","journal-title":"Br J Anaesth"},{"key":"R16-20260803","doi-asserted-by":"crossref","first-page":"16599","DOI":"10.1038\/s41598-024-62495-0","article-title":"The effect of human albumin administration on postoperative renal function following major surgery: A systematic review and meta-analysis","volume":"14","author":"Lee","year":"2024","journal-title":"Sci Rep"},{"key":"R17-20260803","doi-asserted-by":"crossref","first-page":"R191","DOI":"10.1186\/cc9308","article-title":"Hyperoncotic colloids and acute kidney injury: Meta-analysis of randomized trials","volume":"14","author":"Wiedermann","year":"2010","journal-title":"Crit Care"},{"key":"R18-20260803","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1056\/NEJMoa1209759","article-title":"Hydroxyethyl starch or saline for fluid resuscitation in intensive care","volume":"367","author":"Myburgh","year":"2012","journal-title":"N Engl J Med"},{"key":"R19-20260803","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1056\/NEJMoa1204242","article-title":"Hydroxyethyl starch 130\/0.42 versus Ringer's acetate in severe sepsis","volume":"367","author":"Perner","year":"2012","journal-title":"N Engl J Med"},{"key":"R20-20260803","doi-asserted-by":"crossref","first-page":"406","DOI":"10.3925\/jjtc.70.406","article-title":"Evidence-based guidelines for the use of albumin products (revised third edition)","volume":"70","author":"Nozaki","year":"2024","journal-title":"Jpn J Transfus Cell Ther"},{"key":"R21-20260803","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.chest.2024.02.049","article-title":"Use of intravenous albumin: A guideline from the international collaboration for transfusion medicine guidelines (ICTMG)","volume":"166","author":"Callum","year":"2024","journal-title":"Chest"},{"key":"R22-20260803","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1038\/nrneph.2017.2","article-title":"Acute kidney disease and renal recovery: Consensus report of the ADQI 16 workgroup","volume":"13","author":"Chawla","year":"2017","journal-title":"Nat Rev Nephrol"},{"key":"R23-20260803","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R24-20260803","doi-asserted-by":"crossref","first-page":"R204","DOI":"10.1186\/cc2872","article-title":"Acute renal failure-Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group","volume":"8","author":"Bellomo","year":"2004","journal-title":"Crit Care"},{"key":"R25-20260803","doi-asserted-by":"crossref","first-page":"R31","DOI":"10.1186\/cc5713","article-title":"Acute Kidney Injury Network. Report of an initiative to improve outcomes in acute kidney injury","volume":"11","author":"Mehta","year":"2007","journal-title":"Crit Care"},{"key":"R26-20260803","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"R27-20260803","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomized trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R28-20260803","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in nonrandomized studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"R29-20260803","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/ebmental-2019-300117","article-title":"How to perform a meta-analysis with R: A practical tutorial","volume":"22","author":"Balduzzi","year":"2019","journal-title":"Evid Based Ment Health"},{"key":"R31-20260803","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/j.1467-985X.2008.00552.x","article-title":"A re-evaluation of random-effects meta-analysis","volume":"172","author":"Higgins","year":"2009","journal-title":"J R Stat Soc Ser A Stat Soc"},{"key":"R32-20260803","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Series B"},{"key":"R33-20260803","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12874-017-0315-7","article-title":"Trial sequential analysis in systematic reviews with meta-analysis","volume":"17","author":"Wetterslev","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"R34-20260803","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1001\/jamasurg.2025.1683","article-title":"Postoperative 20% albumin infusion and acute kidney injury in high-risk cardiac surgery patients: The ALBICS AKI randomized clinical trial","volume":"160","author":"Balachandran","year":"2025","journal-title":"JAMA Surg"},{"key":"R35-20260803","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1053\/j.jvca.2024.12.041","article-title":"The renal effect of 20% human albumin solution fluid bolus therapy after cardiac surgery: Secondary analysis of HAS FLAIR II","volume":"39","author":"Wigmore","year":"2025","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R36-20260803","doi-asserted-by":"crossref","first-page":"2522327","DOI":"10.1080\/0886022X.2025.2522327","article-title":"Intraoperative 20% albumin infusion and acute kidney injury in on-pump cardiac surgery: A focus on preoperative albumin levels","volume":"47","author":"Zhang","year":"2025","journal-title":"Ren Fail"},{"key":"R37-20260803","doi-asserted-by":"crossref","first-page":"288","DOI":"10.4103\/aca.aca_84_22","article-title":"Effect of albumin usage during cardiopulmonary bypass on postoperative acute kidney injury in cardiac surgery patients: A historical cohort study","volume":"26","author":"Khademi","year":"2023","journal-title":"Ann Card Anaesth"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_345_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:39:16Z","timestamp":1786649956000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_345_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_345_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"2025-11-26","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}