Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta-analysis

Abstract

Background It has been a matter of much debate whether the co-administration of furosemide and albumin can achieve better diuresis and natriuresis than furosemide treatment alone. There is inconsistency in published trials regarding the effect of this combination therapy. We, therefore, conducted this meta-analysis to explore the efficacy of furosemide and albumin co-administration and the factors potentially influencing the diuretic effect of such co-administration. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Medline, and Cochrane databases. Prospective studies with adult populations which comparing the effect of furosemide and albumin co-administration with furosemide alone were included. The outcomes including diuretic effect and natriuresis effect measured by hourly urine output and hourly urine sodium excretion from both groups were extracted. Random effect model was applied for conducting meta-analysis. Subgroup analysis and sensitivity analysis were performed to explore potential sources of heterogeneity of treatment effects. Results By including 13 studies with 422 participants, the meta-analysis revealed that furosemide with albumin co-administration increased urine output by 31.45 ml/hour and increased urine excretion by 1.76 mEq/hour in comparison to furosemide treatment alone. The diuretic effect of albumin and furosemide co-administration was better in participants with low baseline serum albumin levels (< 2.5 g/dL) and high prescribed albumin infusion doses (> 30 g), and the effect was more significant within 12 hours after administration. Diuretic effect of co-administration was better in those with baseline Cr > 1.2 mg/dL and natriuresis effect of co-administration was better in those with baseline eGFR < 60 ml/min/1.73m2. Conclusion Co-administration of furosemide with albumin might enhance diuresis and natriuresis effects than furosemide treatment alone but with high heterogeneity in treatment response. According to the present meta-analysis, combination therapy might provide advantages compared to the furosemide therapy alone in patients with baseline albumin levels lower than 2.5 g/dL or in patients receiving higher albumin infusion doses or in patients with impaired renal function. Owing to high heterogeneity and limited enrolled participants, further parallel randomized controlled trials are warranted to examine our outcome. Registration PROSEPRO ID: CRD42020211002; https://clinicaltrials.gov/.

Ten myths about albumin

“…The treatment effect was more pronounced in patients with serum albumin Fig. 1 Albumin therapy in critical care levels < 2.5 g/dl and higher prescribed albumin infusion doses (> 30 g), but the heterogeneity was high [9]. Importantly, the effect on urine output was more prominent in the first 12 h after co-administration.…”

Venous Leg Compression for Tissue Decongestion in Patients With Worsening Congestive Heart Failure

“…A total of 12 (60%) patients had LVEF ≥50%. The median (p25-p75%) of IVC diameter was 22.5 mm (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Half of the patients displayed IVC diameter ≤21 mm.…”

“…To manage tissue congestion, different approaches aiming to facilitate the intravascular volume recruitment (transferring water from extravascular to an intravascular compartment) by increasing plasmatic osmolarity are used without robust evidence. These strategies included the infusion of loop diuretic together with a saline hypertonic solution or albumin (5,6,18,19). Another approach consists of using pharmacological agents such as SGLT2i or tolvaptan that increase urine-free water elimination (4,20).…”

Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach

“…It is important to highlight the population and methods differences of these previous studies that might explain the results differences. A recent meta-analysis revealed that albumin co-administration increased urine output by 31.45 mL/h and urine sodium excretion by 1.76 mEq/h compared to furosemide alone (Lee et al, 2021). This effect was better in patients with low baseline serum albumin levels (<2.5 g/L) and high albumin infusion dose (>30 g) and within 12 h after administration.…”