Possible Interaction: Albumin and Vasoconstrictor Agents

“The clinical management of hepatorenal syndrome is currently based on the use of a vasoconstrictor in association with albumin.”

“The long-term administration (1-3 weeks) of analogs of vasopressin (ornipressin or terlipressin) or other vasoconstrictors together with plasma volume expansion with albumin is associated with a dramatic improvement in circulatory function and normalization of serum creatinine concentration in patients with severe hepatorenal syndrome.”

“These data suggest that albumin administration reduced the activation of endogenous vasoconstrictor systems and protected patients from further impairment of renal function.”

“That is, HRS has an additional structural component that would not only make traditional diagnostic criteria less reliable but would explain the lack of response to pharmacological treatment with vasoconstrictors plus albumin that correlates with a progressive increase in inflammation.”

“We do agree that albumin can help synergistically the vasoconstrictors.”

“In addition, improvement of circulatory dysfunction with the use of albumin and vasoconstrictors may prevent hepatic encephalopathy in acute-on-chronic liver failure.”

“ Vasoconstrictors plus albumin improve renal function in 40–60% of patients with type 1 HRS.”

“Moreover, results of treatment with vasoconstrictors in hepatorenal syndrome are significantly improved with the use of albumin.”

“ Vasoconstrictors together with albumin can ameliorate the effective arterial blood volume and increase renal perfusion pressure.”

“Conclusion:In hypotensive neonates, ALB results in a greater likelihood of achieving normotension and decreased subsequent use of vasopressors when compared to NS.”