From the Guidelines
Albumin should be used for a maximum of 14 days in patients with Hepatorenal Syndrome (HRS), with the treatment duration tailored to individual patient response and the achievement of specific clinical endpoints, such as improvement in renal function or return of serum creatinine to baseline values 1.
Treatment Duration and Endpoint
The treatment course generally ranges from 5-14 days, with the standard regimen involving an initial albumin dose of 1 g/kg body weight on day one, followed by 20-40 g daily thereafter while vasoconstrictor therapy continues 1.
- The therapeutic rationale for albumin in HRS is to expand plasma volume, improve cardiac output, and enhance the efficacy of vasoconstrictors by counteracting splanchnic vasodilation.
- Albumin also provides oncotic pressure to maintain intravascular volume and has anti-inflammatory and antioxidant properties that may help protect against further kidney injury.
Monitoring and Adjustment
Clinicians should monitor for signs of volume overload during administration, particularly in patients with pulmonary edema or heart failure, and adjust the dose accordingly 1.
- The decision to extend or terminate albumin treatment should be based on clinical judgment, taking into account the patient's response to therapy, potential side effects, and the risk of complications.
Evidence-Based Recommendations
The most recent and highest quality study recommends that albumin treatment be continued either until 24 hours following the return of the serum creatinine level to within ≤0.3 mg/dL of baseline for 2 consecutive days or for a total of 14 days of therapy 1.
- This approach is supported by the American Association for the Study of Liver Diseases and other clinical practice guidelines, which emphasize the importance of individualized treatment and careful monitoring in patients with HRS 1.
From the FDA Drug Label
Patients underwent fluid challenge with intravenous albumin (1 g/kg on the first day (maximum 100 g) and 20 g/day to 40 g/day thereafter as clinically indicated). Both treatment groups received albumin therapy during the study (median dose 50 g/day). Median treatment duration was 5 days for TERLIVAZ-treated patients and 4 days for placebo-treated patients.
The recommended duration of albumin use in patients with Hepatorenal Syndrome (HRS) is not explicitly stated in the provided drug label. However, based on the study, albumin therapy was administered for a maximum of 14 days, as it was part of the treatment period for TERLIVAZ. The median treatment duration was 5 days for TERLIVAZ-treated patients and 4 days for placebo-treated patients 2.
From the Research
Albumin Use in Hepatorenal Syndrome (HRS)
- The recommended duration of albumin use in patients with HRS is not explicitly stated in the provided studies, but treatment durations are mentioned in several studies:
- In the study 3, treatment was allowed for a maximum of 10 days.
- In the study 4, the duration of treatment is not explicitly stated, but albumin was administered at 1 g/kg of body weight on day 1 and 20-40 g/day thereafter.
- In the study 5, the combination of octreotide, midodrine, and albumin was administered, and transplant-free survival was higher in the treatment arm compared to the control arm, with a median survival of 101 days.
Treatment Outcomes
- The use of albumin in combination with other medications, such as terlipressin, norepinephrine, midodrine, and octreotide, has been shown to be effective in improving renal function and survival in patients with HRS 3, 4, 6, 5.
- The study 6 found that terlipressin plus albumin was more efficacious than placebo plus albumin or midodrine plus albumin and octreotide for HRS reversal.
- The study 5 found that the combination of octreotide, midodrine, and albumin improved survival in patients with type 1 and type 2 HRS.
Dosage and Administration
- The dosage and administration of albumin varied across the studies: