Causal relationship between hypoalbuminemia and acute kidney injury

Table 4 Included studies on transplant surgery

Ref.	Population/setting	Study design	Overall study size	Albumin measurement	Hypoalbuminemia-related outcomes
					AKI/ARF	Mortality
Tinti et al[45]	Liver transplantation	Prospective, observational	24	Preoperative albumin level	Lower albumin (3.1 g/dL vs 3.7 g/dL) predictive of ARF (P = 0.02)	ND
Moore et al[48]	Renal transplantation	Retrospective, observational	2763	Albumin < 4.0 g/dL	Predictive of transplant failure: HR = 1.71 (95%CI: 1.18-2.49; P < 0.001)	ND
Sang et al[46]	LDLT	Retrospective, observational, propensity score matching	998 (incl. 249 matched pairs)	Albumin < 3.0 g/dL vs ≥ 3.0 g/dL before surgery	Albumin < 3.0 g/dL associated with increased AKI: OR = 0.42 (95%CI: 0.28-0.64; P < 0.001)	Survival rate lower with postoperative albumin < 3.0 g/dL (P = 0.02)
Park et al[47]	LDLT	Retrospective, observational	538	Preoperative albumin level	Albumin < 3.5 g/dL: OR = 1.76 (95%CI: 1.05-2.94; P = 0.032)	ND
Yang et al[49]	Renal transplantation	Retrospective, observational	375	Preoperative albumin < 3.5 g/dL vs 3.5-3.9 g/dL vs 4.0-4.4 g/dL vs ≥ 4.5 g/dL	Lowest risk of graft failure with ≥ 4.5 g/dL: HR = 0.536 (P = 0.029) vs < 3.5 g/dL	ND
Chen et al[44]	Liver transplantation	Retrospective, observational, matching	334 (incl. 118 matched pairs)	Preoperative albumin ≤ 3.5 g/dL	OR = 2.785 (95%CI: 1.427-5.434; P = 0.003); risk factor for posttransplantation AKI or ARF	ND

AKI: Acute kidney injury; ARF: Acute renal failure; HR: Hazard ratio; LDLT: Living donor liver transplantation; ND: Not disclosed; OR: Odds ratio.