Practice patterns and outcomes associated with intravenous albumin in patients with cirrhosis and acute kidney injury

Background & Aims Guidelines recommend albumin as the plasma‐expander of choice for acute kidney injury (AKI) in cirrhosis. However, the impact of these recommendations on patient outcomes remains unclear. We aimed to determine the practice‐patterns and outcomes associated with albumin use in a...

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Published in:Liver international Vol. 42; no. 1; pp. 187 - 198
Main Authors: Patidar, Kavish R., Adibuzzaman, Mohammad, Naved, Mobasshir A., Rodriquez, Dylan, Slaven, James E., Grama, Ananth, Desai, Archita P., Gomez, Eduardo V., Ghabril, Marwan S., Nephew, Lauren, Samala, Niharika R., Anderson, Melissa, Chalasani, Naga P., Orman, Eric S.
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01.01.2022
Subjects:
Acute Kidney Injury - etiology
AKI recovery
Albumin
Albumins
Albumins - therapeutic use
ascites
Cirrhosis
Clinical trials
Complications
Creatinine
End Stage Liver Disease - complications
Female
Hospitalization
Humans
infection
Intravenous administration
Kidneys
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - drug therapy
Liver diseases
Male
Middle Aged
Patients
portal hypertension
Prospective Studies
Recovery
renal failure
Retrospective Studies
Risk Factors
Severity of Illness Index
Sodium
Subgroups
Survival
United States > US
renal failure
infection
portal hypertension
ascites
AKI recovery
survival
ISSN:1478-3223, 1478-3231, 1478-3231
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Summary:Background & Aims Guidelines recommend albumin as the plasma‐expander of choice for acute kidney injury (AKI) in cirrhosis. However, the impact of these recommendations on patient outcomes remains unclear. We aimed to determine the practice‐patterns and outcomes associated with albumin use in a large, nationwide‐US cohort of hospitalized cirrhotics with AKI. Methods A retrospective cohort study was performed in hospitalized cirrhotics with AKI using Cerner‐Health‐Facts database from January 2009 to March 2018. 6786 were included for analysis on albumin‐practice‐patterns, and 4126 had available outcomes data. Propensity‐score‐adjusted model was used to determine the association between albumin use, AKI‐recovery and in‐hospital survival. Results Median age was 61‐years (60% male, 70% white), median serum‐creatinine was 1.8 mg/dL and median Model for End‐stage Liver Disease Sodium (MELD‐Na) score was 24. Albumin was given to 35% of patients, of which 50% received albumin within 48‐hours of AKI‐onset, and 17% received appropriate weight‐based dosing. Albumin was used more frequently in patients with advanced complications of cirrhosis, higher MELD‐Na scores and patients admitted to urban‐teaching hospitals. After propensity‐matching and multivariable adjustment, albumin use was not associated with AKI‐recovery (odds ratio [OR] 0.70, 95% confidence‐interval [CI]: 0.59‐1.07, P = .130) or in‐hospital survival (OR 0.76 [95% CI: 0.46‐1.25], P = .280), compared with crystalloids. Findings were unchanged in subgroup analyses of patients with varying cirrhosis complications and disease severity. Conclusions USA hospitalized patients with cirrhosis and AKI frequently do not receive intravenous albumin, and albumin use was not associated with improved clinical outcomes. Prospective randomised trials are direly needed to evaluate the impact of albumin in cirrhotics with AKI.
Bibliography:Handling Editor
Luca Valenti
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ISSN:1478-3223
1478-3231
1478-3231
DOI:10.1111/liv.15096