Could the routine use of 20-25% albumin during or after cardiac surgery be putting your patients' kidneys at risk? Human serum albumin (HSA) is widely used for fluid management, but the effects of hyperoncotic (20–25%) albumin on post-cardiac surgery AKI have been debated. Key Findings: Increased AKI Risk With Hyperoncotic AlbuminAdministration of 20–25% albumin was associated with a significant increase in AKI risk (RR 1.10, 95% CI 1.05–1.16). The findings support recent international guidelines recommending against routine use of hyperoncotic albumin for CPB priming or general volume expansion in adult cardiac surgery. Key Points20–25% albumin increases the risk of AKI after adult cardiac surgery versus crystalloids or 4–5% albumin.