Albumin Resuscitation Fails to Prevent Acute Kidney Injury in ICU Patients, Meta-Analysis Finds

A systematic review and meta-analysis of randomized controlled trials has found that human serum albumin, widely used for fluid resuscitation in intensive care, does not significantly reduce the incidence of acute kidney injury in critically ill patients. The analysis, published in Critical Care, pooled data from nine randomized controlled trials encompassing 11,778 patients and concluded that albumin administration did not significantly reduce AKI incidence, reporting a risk ratio of 1.00 with a 95% confidence interval of 0.91 to 1.11 and moderate heterogeneity between trials (I² = 47.2%). The quality of evidence behind this primary finding was rated as low.

The research team systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and clinical trial registries from January 2004 to April 30, 2026 for randomized controlled trials assessing albumin as a resuscitation fluid in critically ill patients. Two reviewers independently identified trials, extracted data and assessed risk of bias. The primary outcome was the occurrence of acute kidney injury. Random-effects meta-analyses were used to calculate risk ratios with 95% confidence intervals, and the GRADE framework was applied to assess the quality of the evidence. Trial sequential analysis was additionally performed to evaluate the robustness of the accumulated evidence.

Beyond the primary renal outcome, the meta-analysis identified a secondary signal that may warrant caution. In four trials, all of which used 20% albumin, albumin administration was associated with a higher rate of renal replacement therapy, with a risk ratio of 1.26 (95% confidence interval 1.07 to 1.48) and low certainty of evidence. Albumin also increased ICU length of stay by a mean difference of 0.33 days (95% confidence interval 0.12 to 0.55), while mortality was unaffected, with a risk ratio of 0.98 (95% confidence interval 0.92 to 1.05).

Trial sequential analysis added an important interpretive layer: the cumulative Z-curve crossed the futility boundary, suggesting that further trials are unlikely to change the primary conclusion regarding acute kidney injury. In other words, the accumulated evidence on this outcome may already be sufficient, and additional studies of similar design would probably not overturn the finding that albumin does not significantly reduce AKI incidence.

The authors’ take-home message states that, in this first meta-analysis focusing on renal outcomes, albumin administration does not significantly reduce the risk of AKI in critically ill patients, with low quality of evidence, and may increase the need for renal replacement therapy with a low-certainty signal that requires confirmation. According to the authors, these findings do not support the routine use of albumin in critically ill patients for the prevention of AKI. The study is an open-access review article published on October 27, 2026, shared early as a peer-reviewed, accepted, citable version subject to further edits before the final Version of Record.

Subject of Research: Albumin fluid resuscitation and acute kidney injury in intensive care patients

Article Title: Association between human serum albumin for fluid resuscitation and acute kidney injury in intensive care: a systematic review and meta-analysis

Article References: Jeanmougin, T., James, A., Collet, L., Constantin, J.-M., Bouglé, A., Dechartres, A., & Hariri, G. (2026). Association between human serum albumin for fluid resuscitation and acute kidney injury in intensive care: a systematic review and meta-analysis. Critical Care. https://doi.org/10.1186/s13054-026-06423-w

Image Credits: AI Generated

DOI: 10.1186/s13054-026-06423-w

Keywords: albumin, acute kidney injury, intensive care, fluid resuscitation, meta-analysis, systematic review, randomized controlled trials, renal replacement therapy, critical care, GRADE, trial sequential analysis, Association