Table 1.

Potential benefits and risks of intravenous albumin for patients on KRT

Benefits/Risks	Related Evidence	Comments
Potential benefits
Reduced hypotension, enhanced ultrafiltration	No data support use of iso-oncotic albumin. Hyperoncotic albumin trials report hemodynamic benefits (Table 3)	<150 patients included across all trials
Anti-inflammatory effects	Patients on maintenance treated with 20% albumin have reduced markers of inflammation (Supplemental Table 1)	Potential effect on patient outcomes is unclear
Potential risks
Unnecessary fluid accumulation	Observational data: less net fluid removal reported for inpatient HD sessions when 25% albumin was given	This finding likely confounded according to indication for albumin use
AKI due to hyperoncotic albumin administration	Finding of recent observational studies but hyperoncotic albumin never found to cause AKI across multiple trials	Implications for kidney recovery in AKI, preservation of residual function in HD. Trial data are very reassuring
Aluminum toxicity	Historically, trace metals were introduced during manufacturing	Very unlikely given manufacturing improvements
Infection	Theoretical risk of transmission of viruses, prions	No cases have been reported
Other	Anaphylaxis and hypotension have been reported	Extremely rare relative to other blood products

HD, hemodialysis.