Editorial Views  |   May 2016
Albumin Supplementation as a Therapeutic Strategy in Cardiac Surgery: Useful Tool or Expensive Hobby?
Author Notes
  • From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Corresponding article on page 1001.
    Corresponding article on page 1001.×
  • Accepted for publication December 4, 2015.
    Accepted for publication December 4, 2015.×
  • Address correspondence to Dr. Jiang: yandong.jiang@vanderbilt.edu
Article Information
Editorial Views / Cardiovascular Anesthesia
Editorial Views   |   May 2016
Albumin Supplementation as a Therapeutic Strategy in Cardiac Surgery: Useful Tool or Expensive Hobby?
Anesthesiology 5 2016, Vol.124, 983-985. doi:10.1097/ALN.0000000000001052
Anesthesiology 5 2016, Vol.124, 983-985. doi:10.1097/ALN.0000000000001052
Acute kidney injury (AKI) is a common complication associated with on-pump coronary artery bypass and off-pump coronary artery bypass (OPCAB) graft surgery.1,2  The etiology of cardiac surgery–associated AKI is not well understood, and it is almost certainly multifactorial. Apart from intrinsic patient factors (such as comorbidities), the insult from the use of cardiopulmonary bypass (CPB) for on-pump coronary artery bypass graft surgery plays a major role. This is mainly due to (1) blood interfacing with a large extracorporeal surface and triggering a systemic inflammatory response and (2) disabling the filtering effect of the lungs, allowing microemboli to enter the systemic circulation (renal vasculature) directly and cause kidney injury. Therefore, avoiding CPB by the use of OPCAB should theoretically reduce AKI and other complications associated with CPB. However, even though the incidence of AKI seems lower with OPCAB than with on-pump coronary artery bypass surgery,3  this reduction is very marginal and by no means conclusive.4  The incidence of severe kidney injury requiring renal replacement therapy associated with these two approaches is actually fairly similar.5  Therefore, this implies that there are other contributing factors associated with OPCAB. It is critical to identify and modify these factors. One of the potentially modifiable factors for AKI associated with OPCAB is a preexisting low level of albumin.6 
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