Expert perspectives for the pharmacist on facilitating and improving the use of albumin in cirrhosis

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Albumin, the most abundant and arguably most important protein in the human body, plays a unique role in decompensated cirrhosis because its structure and function are quantitatively and qualitatively affected. A literature review was performed to provide insights into albumin use. The manuscript was developed using a multidisciplinary approach; 2 hepatologists, a nephrologist, a hospitalist, and a pharmacist, who are all members of or work closely with the Chronic Liver Disease Foundation, collaborated to write this expert perspective review. Summary Cirrhosis represents the potential end in the spectrum of all chronic liver diseases. Decompensated cirrhosis, defined by the overt manifestation of liver failure (eg, ascites, hepatic encephalopathy, variceal bleeding), is the inflection point associated with increased mortality. Human serum albumin (HSA) infusion serves an important role in the treatment of advanced liver disease. The benefits of HSA administration in patients with cirrhosis are widely accepted, and its use has been advocated by several professional societies. However, inappropriate HSA use can lead to significant adverse patient events. This paper discusses the rationale for the administration of HSA in the treatment of complications of cirrhosis, analyzes the data on the use of HSA in cirrhosis, and streamlines practical recommendations set forth in published guidance. Conclusion Use of HSA in clinical practice needs to be improved. The objective of this paper is to empower pharmacists to facilitate and improve the use of HSA in patients with cirrhosis at their practice sites.

Identifying new safety risk of human serum albumin: a retrospective study of real-world data

“…HSA plays an important role in maintaining plasma colloid osmolality and should be administered slowly, as an infusion of high doses of HSA over a short period can lead to an excessive increase in circulating blood volume and an increased risk of pulmonary oedema ( Jagdish et al, 2021 ). Kugelmas et al (2023) suggest that attention must also be paid to the sodium content of HSA, as high sodium can lead to pulmonary oedema, and that one must be careful when combining it with vasoconstrictors. Special attention should be paid to the occurrence of lung injury and pulmonary oedema in female patients after the use of HSA.…”

“…If given in high doses over a short period, it can lead to an excessive increase in blood volume and an increased risk of pulmonary oedema. It is important to note that the sodium content of HSA needs to be monitored, as high levels can cause pulmonary oedema ( Kugelmas et al, 2023 ). Additionally, combining it with vasoconstrictors requires caution.…”