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Review
. 2023 Mar 4;12(3):515.
doi: 10.3390/antibiotics12030515.

Hypoalbuminemia and Pharmacokinetics: When the Misunderstanding of a Fundamental Concept Leads to Repeated Errors over Decades

Peggy Gandia  1   2 , Sarah Decheiver  1 , Manon Picard  1 , Romain Guilhaumou  3 , Sarah Baklouti  1   2 , Didier Concordet  2
Affiliations
Review

Hypoalbuminemia and Pharmacokinetics: When the Misunderstanding of a Fundamental Concept Leads to Repeated Errors over Decades

Peggy Gandia et al. Antibiotics (Basel). .

Abstract

Surprisingly, misinterpretation of the influence of hypoalbuminemia on pharmacokinetics and the clinical effects of drugs seems to be a current problem, even though hypoalbuminemia has no impact on the pharmacologically active exposure. Exceptions to this fact are highly protein-bound anaesthetics with high elimination capacity (i.e., <5 drugs on the market). To assess the frequency of misinterpretation of the influence of hypoalbuminemia on pharmacokinetics and the clinical effects of drugs between 1975 and 2021, a PubMed literature review was conducted. Each paragraph on albumin binding was classified as correct, ambiguous or incorrect, creating two acceptable categories: (1) content without any errors, and (2) content containing some incorrect and/or ambiguous statements. The analyses of these articles showed that fewer than 11% of articles contained no interpretation errors. In order to contain this misinterpretation, several measures are proposed: (1) Make the message accessible to a wide audience by offering a simplified and didactic video representation of the lack of impact of albumin binding to drugs. (2) Precise terminology (unbound/free form/concentration) should be used for highly bound drugs. (3) Unbound/free forms should be systematically quantified for highly plasma protein bound drugs for clinical trials as well as for therapeutic drug monitoring.

Keywords: hypoalbuminemia; misinterpretation; therapeutic drug monitoring; unbound/free concentration.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart describing PubMed review regarding unbound/free fractions/concentrations. This flowchart has been produced using the guidelines provided in [15].
Figure 2
Figure 2
Diagram showing the articles available on PubMed when we reviewed the literature.
See this image and copyright information in PMC

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