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General Audience Summary

Background: Sudden damage to the kidneys, causing a decrease in their function, is called acute kidney injury (AKI). AKI often happens to critically ill patients in an intensive care unit (ICU). Dialysis is a blood-cleaning procedure that replaces some of the kidneys’ usual functions. For patients with severe AKI, dialysis can be life-saving. Patients that need dialysis for severe AKI have a very high risk of death (50% or more), require long stays in ICU and incur high costs to the health care system. Many patients who survive don’t recover enough kidney function to stop dialysis treatments when they are discharged from ICU. Sometimes they require dialysis permanently afterwards. Dialysis does not repair kidney damage but does prevent death from kidney failure. This allows damaged kidneys and other organs to heal over time. In fact, dialysis itself may cause additional damage. Additional damage occurs because critically ill patients often have a drop in their blood pressure (hypotension) caused by dialysis treatments. The hypotension caused by dialysis is harmful to the kidneys, heart, and other organs. As a result, hypotension during dialysis may increase the risk of death and limit kidney recovery. Albumin is a protein normally found in the blood. Patients with higher levels of albumin in their blood have less hypotension during dialysis. Intravenous albumin is a blood product that is widely used to treat hypotension. Some doctors prescribe intravenous albumin to be given to critically ill patients during dialysis to prevent hypotension. However, the use of intravenous albumin for this purpose depends more on doctors' preferences than science, data, or evidence. Intravenous albumin is also very expensive. Our research team recently completed a study showing intravenous albumin prevents hypotension during dialysis in critically ill ICU patients with AKI. This study had too few patients to determine if intravenous albumin has an impact on outcomes that are most important to patients such as the risk of death or the need for permanent dialysis.

Method: We will undertake a study of patients with AKI that need dialysis for AKI in an ICU at 5 Canadian hospitals. Patients that consent to the study will be randomly assigned to be given either intravenous albumin or an equal amount of a placebo (saline intravenous fluid) during dialysis treatments. We will then measure the difference in the numbers of patients that die or need permanent dialysis in the two groups to determine if intravenous albumin is effective.

Conclusion: If this study finds intravenous albumin reduces death or the need for permanent dialysis, it is a widely available treatment that can be used for more patients with severe AKI. If not, an expensive but ineffective treatment that is already being used by some doctors can be stopped with the money currently spent on intravenous albumin being better used elsewhere.