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Abstract: FR-PO667

Is There a Role for Concomitant Administration of Albumin and Diuretics? A Meta-Analysis

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Chamarthi, Gajapathiraju, University of Florida, Gainesville, Florida, United States
  • Lee Loy, Justin, University of Florida, Gainesville, Florida, United States
  • Norton, Hannah F., University of Florida, Gainesville, Florida, United States
  • Bejjanki, Harini, University of Florida, Gainesville, Florida, United States
  • Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States
Background

Diuretics are the cornerstone of volume management in patients with disease states such as heart failure, nephrotic syndrome and cirrhosis. Diuretic resistance is commonly encountered in such patients and is often attributed to hypoalbuminemia. Albumin is sometimes empirically used to increase diuretic efficacy in these patients. We sought to systematically study the effect of albumin combined with diuretics on urine volume and urine sodium in patients with hypoalbuminemia.

Methods

Systemic search of electronic databases from inception until June 2018 was performed. We included clinical studies in patients with hypoalbuminemia that included more than 5 subjects, comparing co-administration of albumin and diuretics versus loop diuretics alone. A total of 754 records were screened independently by two investigators. 26 full text articles were assessed for eligibility. Synthesis of data was done using meta-analysis techniques using Revman Software.

Results

There were 9 eligible studies which met the criteria and had the required data. All of them were cross over studies. 6 of the studies were done exclusively in nephrotic syndrome patients, one of which included pediatric subjects. There was a statistically significant increase in urine volume of 315 ml (95% CI 183.04, 448.33) and urine sodium of 27 meq (95% CI 7.46, 46.59) at 8 hours with co-administration of albumin and furosemide compared to furosemide alone[fig]. There was no statistically significant increase in the 24 hour urine output 385 ml (95% CI -141.92, 911.68).

Conclusion

Our results suggest that in patients with hypoalbuminemia, co-administration of albumin and furosemide increases urine output and sodium excretion at 8 hours. There were no differences in urine volume at 24 hours, but most these studies used single doses or few hours of diuretic infusions. Randomized controlled trials in patients with defined diuretic resistance is required to confirm the efficacy of co-administration of albumin and furosemide.