Contribution of diuretic therapy with human serum albumin to the management of ascites in patients with advanced liver cirrhosis: A prospective cohort study

Abstract

Abstract. The number of available studies on the role of human serum albumin (HSA) in the treatment of cirrhotic ascites is currently limited. In this study, we aimed to investigated the parameters associated with diuretic therapy with HSA in patients with advanced cirrhotic ascites. The patient inclusion criteria were cirrhotic ascites and a serum albumin (Alb) concentration of <3.5 g̸dl. A total of 49 patients registered and 38 patients were ultimately included in this study. The enrolled patients were mainly treated with oral spironolactone and furosemide, which were not specified; the HSA amount was also not specified, although the administration period was set to a maximum of 7 days. Our results demonstrated that the administration of HSA significantly increased the serum levels of Alb [0.97 g̸dl; two-sided 95% confidence interval (CI): 0.83-1.11 g̸dl] and decreased body weight (-2.24 kg; 95% CI: -3.06 to -1.43 kg), hematocrit ratio (0.96; 95% CI: 0.94-0.98) and plasma renin concentration (day 4; geometric mean fold change, -0.1528; 95% CI: -0.2510 to -0.0545; log-transformed data) in patients with advanced cirrhotic ascites. The observed weight loss was found to be correlated with the total amount of HSA administered (P=0.0012), as indicated by the results of the multiple linear regression analysis. In conclusion, this study confirmed the efficacy of HSA in patients with advanced cirrhotic ascites.

Long‐term albumin administration in patients with cirrhosis and ascites: A meta‐analysis of randomized controlled trials

“…After removing duplicates, 1350 articles were reviewed by title and abstract screening according to the eligibility criteria. Twenty‐five studies were selected for full‐text review, 20 of which were excluded for not meeting some of the inclusion criteria or for meeting the exclusion criterion 15–34 . Finally, five studies were included in this systematic review 7–11 .…”

Clinical Use of Diuretics in Heart Failure, Cirrhosis, and Nephrotic Syndrome

“…In a prospective cohort study, human serum albumin was administered to patients who had serum albumin concentration less than 3.5 g/dL and were being treated with furosemide and spironolactone. The body weight loss recorded was dependent upon the amount of human serum albumin administered instead of the dose of diuretics [ 56 ]. A reduction in plasma renin concentration was observed in patients treated with human serum albumin combined with diuretic therapy [ 57 ].…”

Utilization of aquapheresis among hospitalized patients with end‐stage liver disease: A case series and literature review

“…Kidney dysfunction, whether resulting from AKI or from pre‐existing chronic kidney disease (CKD) can limit successful volume removal with diuresis. Albumin is sometimes administered concurrently with diuretic therapy in an attempt to preserve kidney function during diuresis, but this practice is mainly driven by anecdotal experience, is costly, and has limited data to support its use 8,9 . Progressive AKI, especially in the context of suspected hepatorenal syndrome (HRS‐AKI) often necessitates cessation of diuretic therapy.…”

“…Albumin is sometimes administered concurrently with diuretic therapy in an attempt to preserve kidney function during diuresis, but this practice is mainly driven by anecdotal experience, is costly, and has limited data to support its use. 8,9 Progressive AKI, especially in the context of suspected hepatorenal syndrome (HRS-AKI) often necessitates cessation of diuretic therapy. If kidney function does not improve following cessation of diuretics, guidelines recommend a relatively large volume of albumin (1 g/kg/day for 48 h) be administered to replace intravascular volume.…”