Albumin is a protein that helps maintain fluid balance and transport various substances throughout the body. Dialysis is a medical procedure that filters waste and excess fluid from the blood when kidneys fail. For individuals undergoing dialysis, especially hemodialysis, albumin administration can be a necessary part of their care to manage specific conditions.
Understanding Albumin and Dialysis
Albumin, the most abundant protein in blood plasma, is important for several bodily functions. It helps maintain oncotic pressure, the pulling force that keeps fluid within blood vessels, preventing leakage into surrounding tissues. Albumin also acts as a transport protein, binding to and carrying hormones, fatty acids, and various medications through the bloodstream.
When kidneys fail, dialysis becomes a life-sustaining treatment, with hemodialysis being a common form. During hemodialysis, a machine acts as an artificial kidney, filtering waste products and excess fluid from the blood. Blood is drawn from the patient, passed through a specialized filter called a dialyzer, where waste and fluid are removed, and then returned to the body. This process typically occurs several times a week, with each session lasting around four hours.
Why Albumin is Administered During Dialysis
Albumin administration during dialysis primarily addresses specific physiological challenges that can arise due to kidney failure and the dialysis process. One common reason is to manage intradialytic hypotension, a significant drop in blood pressure during a dialysis session. Rapid fluid removal during dialysis can lead to a decrease in blood volume, causing hypotension, and albumin helps by drawing fluid back into the blood vessels, thereby stabilizing blood pressure.
Another indication for albumin administration is in patients experiencing fluid overload alongside low albumin levels. When albumin levels are low, the body’s ability to retain fluid within the blood vessels is compromised, leading to fluid accumulation in tissues and making effective fluid removal during dialysis more challenging. By increasing the oncotic pressure, albumin helps mobilize this excess fluid from the tissues back into the circulation, making it available for removal by the dialyzer.
Albumin may also be considered for nutritional support in severely malnourished patients. Additionally, albumin’s ability to bind to and transport various substances, including certain toxins and drugs, can be relevant in dialysis patients. This binding capacity can influence the effectiveness of removing highly protein-bound toxins during dialysis.
The Administration Process
Administering albumin during dialysis is a medical procedure performed by trained healthcare professionals. The process begins with careful preparation, including verifying the correct type and concentration of albumin, typically 5% or 25% solutions, and checking the expiration date. The specific concentration chosen depends on the patient’s clinical needs, with 25% albumin often used when fluid restriction is necessary.
Albumin is administered intravenously (IV) into the patient’s bloodstream. This is commonly done through the patient’s existing dialysis access, such as a fistula, graft, or central line, ensuring it is infused directly into the bloodstream and not into the dialyzer. The infusion is typically given slowly, over 30 to 60 minutes, to prevent rapid fluid shifts and potential adverse reactions. An IV pump is used to control the infusion rate precisely.
During the albumin infusion, the patient’s vital signs, including blood pressure, heart rate, and respiratory rate, are continuously monitored by the healthcare team. This close observation allows for the early detection of any immediate symptoms or reactions, such as flushing, mild fever, chills, or nausea. The team also watches for any signs of allergic reactions.
Potential Considerations and Monitoring
Following albumin administration during dialysis, the medical team closely monitors the patient for expected outcomes. Primary goals include stabilizing blood pressure, particularly if the patient was hypotensive, and improving the efficiency of fluid removal during the dialysis session. Patients might also experience a reduction in symptoms such as cramping, which can be associated with rapid fluid shifts.
While generally well-tolerated, albumin infusions can lead to some reactions. Common side effects may include mild fever, chills, nausea, or a rapid heart rate. More serious, though rare, allergic reactions like hives or difficulty breathing can occur.
Fluid balance management is an important consideration after albumin infusion. The medical team may adjust the remaining fluid removal plan for the dialysis session based on how the patient responded to the albumin. This ensures that the patient achieves their target dry weight without experiencing fluid overload. Albumin administration is not a routine part of every dialysis session; it is reserved for specific medical indications when deemed beneficial by the healthcare provider.