From the Guidelines
The use of albumin infusion followed by intravenous diuretics is supported in specific clinical scenarios, such as hepatorenal syndrome and refractory ascites in cirrhosis patients, particularly those with hypoalbuminemia and a poor response to diuretics alone, as evidenced by a recent study published in 2024 1.
Clinical Scenarios
The combination therapy may be beneficial in the following scenarios:
- Hepatorenal syndrome
- Refractory ascites in cirrhosis patients
- Patients with hypoalbuminemia and cirrhosis who have a poor response to diuretics alone
Typical Regimen
The typical regimen involves administering 25-50g of albumin (as a 20-25% solution) intravenously over 2-4 hours, followed by loop diuretics such as furosemide (20-40mg IV) or torsemide (10-20mg IV), as supported by a study published in 2021 1.
Rationale
The rationale behind this approach is that albumin helps expand intravascular volume, improves oncotic pressure, and enhances renal perfusion, which may potentiate the effect of diuretics by increasing delivery to their site of action, as explained in a study published in 2021 1. Additionally, albumin binds to diuretics, potentially prolonging their half-life and effectiveness.
Monitoring
Close monitoring of electrolytes, renal function, and hemodynamic status is essential during this treatment, as emphasized in a study published in 2021 1.
Evidence
The evidence for this approach is primarily based on studies published in 2021 and 2024, which demonstrated the benefits of albumin infusion in specific patient populations, including those with hepatorenal syndrome and refractory ascites in cirrhosis patients 1.
From the Research
Albumin Infusion and IV Diuretics
- The use of albumin infusion followed by IV diuretics is a common practice in the treatment of ascites in patients with liver cirrhosis 2, 3, 4.
- Albumin infusion is effective in preventing circulatory dysfunctions after large-volume paracentesis and renal failure, and is also used in the treatment of hepatorenal syndrome (HRS) 3, 4.
- The combination of albumin and furosemide has been shown to be effective in mobilizing refractory ascites in decompensated chronic liver disease, with improved diuresis and hemodynamic stability 5.
- The infusion of furosemide and albumin has been found to be a safer and more effective therapeutic option in the management of refractory ascites, with better natriuresis, higher urine output, and higher decrement in abdominal circumference and body weight, and lesser side effects 5.
Mechanism of Action
- Albumin plays a pivotal role in modulating the distribution of fluid between body compartments, and its administration is effective in restoring plasmatic oncotic pressure 3.
- The combination of albumin and a loop diuretic, such as furosemide, may improve edema by diuresis and natriuresis, although the response to this combination therapy has not been observed in all studies 6.
Clinical Studies
- A study published in the Journal of Nepal Health Research Council found that infusion therapy with furosemide and albumin was more effective than bolus therapy in the management of refractory ascites, with significantly better diuresis, natriuresis, and decrease in abdominal circumference and body weight 5.
- A review of clinical studies published in the journal Cells discussed the physiology of diuresis and natriuresis of the combination therapy of albumin and a loop diuretic, and provided a brief summary of various studies that have used this combination to improve diuretic-resistant edema 6.