Effect of Albumin Infusion on Renal Outcomes in Sepsis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
DOI:
https://doi.org/10.54097/4mqx5676Keywords:
Albumin, Acute Kidney Injury, Fluid Resuscitation, Meta-analysis, Pulmonary Edema, Renal Replacement Therapy, SepsisAbstract
Sepsis is a severe systemic inflammatory condition often complicated by acute kidney injury (AKI). Although albumin is widely applied for fluid resuscitation with theoretical renoprotective effects, its optimal administration and actual influence on renal function remain unclear. This study aimed to explore whether albumin infuseon reduces the risk of renal injury in adult patients with sepsis. Methods: We systematically searched CENTRAL, Embase, and MEDLINE from database inception to May 20, 2026 to retrieve eligible randomized controlled trials (RCTs) comparing human albumin infusion with alternative fluid therapies in adult septic patients. The primary outcome was the incidence of AKI. Secondary outcomes included the requirement for renal replacement therapy (RRT), 90-day mortality, and pulmonary edema. Pooled risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated via a random-effects model. Results: A total of nine RCTs involving 5003 participants were included. Compared with control fluid regimens, albumin infusion was not associated with a decreased risk of AKI (RR 1.04, 95% CI 0.95–1.13, P = 0.41). No significant intergroup differences were observed regarding RRT requirement (RR 1.06, 95% CI 0.94–1.20, P = 0.34) or 90-day mortality (RR 0.98, 95% CI 0.90–1.08, P = 0.74). Nevertheless, albumin infusion significantly elevated the risk of pulmonary edema (RR 2.38, 95% CI 1.28–4.42, P = 0.006). Subgroup analyses confirmed neutral renal effects of albumin regardless of albumin concentration (20% vs. 4–5%). Conclusions: Albumin infusion fails to lower AKI risk or improve survival outcomes among septic patients, whereas it significantly increases the risk of pulmonary edema. Routine albumin resuscitation cannot be recommended for sepsis treatment; individualized fluid management should be prioritized in clinical practice.
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