Albumin in Cirrhosis: More Than a Colloid

  • Cary H. PaineEmail author
  • Scott W. Biggins
  • Raimund H. Pichler
Liver (J Bajaj, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Liver


Purpose of review

Albumin has repeatedly been shown to be beneficial in treating patients with decompensated cirrhosis. We reviewed the medical literature regarding indications for the use of intravenous albumin in cirrhosis, with particular focus on the ways in which albumin can help mitigate hepatorenal physiology.

Recent findings

Albumin has long been used as the preferred agent for volume expansion in patients with decompensated cirrhosis. It is used in conjunction with vasoconstrictors for the treatment of type 1 hepatorenal syndrome, and in combination with antibiotics for the treatment of spontaneous bacterial peritonitis. When given at the time of large volume paracentesis, albumin is known to help reduce the incidence of post-paracentesis circulatory dysfunction. Recently, albumin has been shown to improve outcomes in hospitalized patients with cirrhosis and hyponatremia, and has also shown promise in reducing mortality and hospitalizations in outpatients with both diuretic resistant and uncomplicated ascites. It is increasingly clear that these benefits derive from a combination of the oncotic and non-oncotic properties of albumin, and from the effects of albumin administration on effective arterial blood volume.


Albumin is an effective treatment for multiple complications encountered in patients with decompensated cirrhosis.


Cirrhosis Albumin Hepatorenal syndrome Ascites Hyponatremia 


Compliance with Ethical Standards

Conflict of Interest

Cary H. Paine declares that he has no conflict of interest. Scott W. Biggins declares that he has no conflict of interest. Raimund H. Pichler declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Cary H. Paine
    • 1
    Email author
  • Scott W. Biggins
    • 2
    • 3
  • Raimund H. Pichler
    • 1
  1. 1.Division of Nephrology (Kidney-Liver Program), Department of MedicineUniversity of WashingtonSeattleUSA
  2. 2.Division of Gastroenterology, Department of MedicineUniversity of WashingtonSeattleUSA
  3. 3.Center for Liver Investigation Fostering discovEry (C-LIFE)University of WashingtonSeattleUSA

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