AISF-SIMTI Position Paper: The appropriate use of albumin in patients with liver cirrhosis

Caraceni, Paolo; Angeli, Paolo; Prati, Daniele; Bernardi, Mauro; Alessandria, Carlo; Riggio, Oliviero; Salerno, Francesco; Liumbruno, Giancarlo Maria; Bennardello, Francesco; Piccoli, Pierluigi; Velati, Claudio; Berti, Pierluigi; Facco, Giuseppina; Fiorin, Francesco

doi:10.1016/j.dld.2015.11.008

Cited by 32 publications

(35 citation statements)

References 93 publications

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“…The study If management of condition is refractory to sodium restriction (90mmol/day), HA may be considered (Liumbruno et al, 2009). In patients with cirrhosis: HA may be indicated as option if there are concerns regarding use of synthetic colloids or crystalloids (volume overload, renal failure, coagulopathy) (Stanford Health Care, 2017; Guy's and St. Thomas' NHS Foundation Trust, 2015;Caraceni et al, 2016).…”

Section: Institutional Protocol: Therapeutic Indicationmentioning

confidence: 99%

“…In patients with cirrhosis: Should be use HA and avoid combinations with other plasma expanders to reduce the dose of HA. Consider oral midodrine or terlipressin, mainly in critical care (Guy's and St. Thomas' NHS Foundation Trust, 2015;Caraceni et al, 2016;National Plasma Products Expert Advisory Group -Scotland NHS, 2016;Ontario Regional Blood Coordinating Network, 2012). 20 g of albumin 20% per every 3L ascites drained or 20 g of albumin per every 2L if renal function impaired (Guy's and St. Thomas' NHS Foundation Trust, 2015; National Plasma Products Expert Advisory Group -Scotland NHS, 2016).…”

Section: Institutional Protocol: Therapeutic Indicationmentioning

confidence: 99%

“…6 to 8 g of albumin 25% per every liter ascitic fluid removed (Vermeulen, Ratko, Erstad, 2010;Liumbruno et al, 2009;Stanford Health Care, 2017;Caraceni et al, 2016).…”

Section: Institutional Protocol: Therapeutic Indicationmentioning

confidence: 99%

“…From this consensus, countries such as Australia, Canada, Spain, France and Italy have also established committees and developed clinical practice guidelines or clinical protocols. Thus, the therapeutic indications of HA were classified as: 1) Approved indications, with convincing evidence; 2) Indications not approved, but with potential clinical benefit, most of the time with inconclusive evidence; 3) Indications not recommended (Casuccio et al, 2015;Vermeulen, Ratko, Erstad, 2010;Liumbruno et al, 2009;Stanford Health Care, 2017;Guy's and St. Thomas' NHS Foundation Trust, 2015;Caraceni et al, 2016;National Plasma Products Expert Advisory Group -Scotland NHS, 2016;Ontario Regional Blood Coordinating Network, 2012;Lyu et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

Ishida

Sakai

Melo

2018

Braz. J. Pharm. Sci.

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The objective of the study was to evaluate the use of human albumin in a Brazilian university hospital, in compliance with the institutional protocol and other clinical guidelines, taking into account the therapeutic indications and the dosage regimens. Data was obtained from the pharmacy dispensing records of human albumin, the requests for use it and, when available, the patient's records between January and October 2017. After evaluation the therapeutic indications and the dosage regimens were classified as "appropriate" and "inappropriate". The analysis of 98 requests showed that, when compared to the institutional protocol, 54 (55.1%) requests had an inappropriate therapeutic indication. However, when a comparison was made between 25 medical records (54 requests) and other clinical guidelines, it was observed that the therapeutic indication had none classified as inappropriate. In addition, 16 (29.7%) requests were considered inappropriate in relation to dosage regimens. From these results, it was possible to conclude that although the use of human albumin in the hospital was associated to a clinical protocol, it was outdated. Thus, it is possible to affirm that not only the adoption of a clinical protocol, but its periodical updating is an important strategy to promote the rational use of drugs.

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Section: Institutional Protocol: Therapeutic Indicationmentioning

confidence: 99%

Section: Institutional Protocol: Therapeutic Indicationmentioning

confidence: 99%

“…6 to 8 g of albumin 25% per every liter ascitic fluid removed (Vermeulen, Ratko, Erstad, 2010;Liumbruno et al, 2009;Stanford Health Care, 2017;Caraceni et al, 2016).…”

Section: Institutional Protocol: Therapeutic Indicationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

Ishida

Sakai

Melo

2018

Braz. J. Pharm. Sci.

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“…Albumin is not a simple plasma expander but has other advantages as detoxification of reactive oxygen and nitrogen species, endothelial stabilization and platelet antiaggregation, and modulation of the immune and inflammatory responses [7]. The main drawback is that the drug is costly, so searching for alternatives is highly warranted [8].…”

mentioning

confidence: 99%

High efficacy of low-dose albumin infusion in the prevention of paracentesis-induced circulatory dysfunction

Alsebaey

Rewisha

Waked

2020

Egypt Liver Journal

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Background: Large-volume paracentesis (LVP) is a main pillar in treating patients with tense ascites. Without plasma expanders use, paracentesis-induced circulatory dysfunction (PICD) is a common complication with decreased survival. The aim was to compare low-dose albumin (2 g/L ascitic fluid removed n = 85) with standarddose albumin (6 g/L ascitic fluid removed, n = 25) for prevention of PICD. Liver function tests, urea, creatinine, CBC, and abdominal ultrasonography were done. Plasma renin activity (PRA) was measured at baseline and on the 6th day post-LVP. The delta change (Δ) = day 6 variable minus baseline variable value. PICD was defined as increase in PRA of > 50% of the baseline value. Results: Patients in low-dose albumin group were mainly Child B compared with Child C (85.9% vs. 52%; p = 0.001), underwent less paracentesis volume (9.78 ± 3.56 vs. 12.52 ± 3.6 L; p = 0.001), but had higher baseline PRA (859.62 ± 1151.34 vs. 165.93 ± 95.34 pg/mL; p = 0.001). In both groups, the PRA increased at day 6 compared with the baseline (1141.57 ± 1433.01 vs. 859.62 ± 1151.34 pg/mL; p = 0.01) and (192.21 ± 80.99 vs. 165.93 ± 95.34 pg/ mL; p = 0.01) respectively. Both groups were comparable for Δ PRA (281.95 ± 851.4 vs. 26.28 ± 30.2 pg/mL; p = 0.102) and PRA percent increase (10.97 ± 30.77 vs. 12.57 ± 14.87; p = 0.844). They had comparable PICD incidence (24.7% vs. 12%; p = 0.27). Females were more liable for PICD occurrence than males (OR 2.91, 95% CI 1.125-7.547, p = 0.028) and so Child B patients than Child C (OR 8.4, 95% CI 1.072-65.767, p = 0.043). Conclusion: Low-dose albumin infusion is comparable to the standard-dose albumin for the prevention of PICD.

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Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis

Simonetti

Nikolova

Bjelaković

et al. 2019

Cochrane Database of Systematic Reviews

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AISF-SIMTI Position Paper: The appropriate use of albumin in patients with liver cirrhosis

Cited by 32 publications

References 93 publications

The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

High efficacy of low-dose albumin infusion in the prevention of paracentesis-induced circulatory dysfunction

Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis

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