Effect of Albumin on Diuretic Response to Furosemide in Patients With Hypoalbuminemia

Doungngern, Thitima; Huckleberry, Yvonne; Bloom, John W.; Erstad, Brian L.

doi:10.4037/ajcc2012999

Cited by 23 publications

(27 citation statements)

References 11 publications

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“…Some studies have suggested that the concurrent use of albumin may increase furosemide-induced diuresis in hypooncotic patients with acute respiratory distress syndrome/acute lung injury [65,66] and cirrhosis-induced ascites [67], although not in all critically ill patients [68]; whether this strategy has any effect on patient-centered clinical outcomes is unclear.…”

Section: Some Backgroundmentioning

confidence: 99%

Albumin administration in the acutely ill: what is new and where next?

et al. 2014

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Albumin solutions have been used worldwide for the treatment of critically ill patients since they became commercially available in the 1940s. However, their use has become the subject of criticism and debate in more recent years. Importantly, all fluid solutions have potential benefits and drawbacks. Large multicenter randomized studies have provided valuable data regarding the safety of albumin solutions, and have begun to clarify which groups of patients are most likely to benefit from their use. However, many questions remain related to where exactly albumin fits within our fluid choices. Here, we briefly summarize some of the physiology and history of albumin use in intensive care before offering some evidence-based guidance for albumin use in critically ill patients.

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Section: Some Backgroundmentioning

confidence: 99%

Albumin administration in the acutely ill: what is new and where next?

et al. 2014

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“…41 Small studies have shown that coadministration of albumin with diuretics in refractory diuretic-resistant edema confers modest clinical benefit, a finding that warrants confirmation with large, prospective studies. 42 The first step in the evaluation of patients with hypoproteinemia is to exclude other common causes like malnutrition or liver and renal disease. The most commonly used and reliable method to determine enteric protein loss is to determine the clearance of α-1 antitrypsin (A1AT) from plasma.…”

Section: Protein-losing Enteropathymentioning

confidence: 99%

Gastrointestinal and Liver Issues in Heart Failure

2016

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Abstract-Heart failure affects ≈23 million people worldwide and continues to have a high mortality despite advancements in modern pharmacotherapy and device therapy. HF is a complex clinical syndrome that can result in the impairment of endocrine, hematologic, musculoskeletal, renal, respiratory, peripheral vascular, hepatic, and gastrointestinal systems. Although gastrointestinal involvement and hepatic involvement are common in HF and are associated with increased morbidity and mortality, their bidirectional association with HF progression remains poorly fathomed. The current understanding of multiple mechanisms, including proinflammatory cytokine milieu, hormonal imbalance, and anabolic/ catabolic imbalance, has been used to explain the relationship between the gut and HF and has been the basis for many novel therapeutic strategies. However, the failure of these novel therapies such as anti-tumor necrosis factor-α has resulted in further complexity. Key Words: gastrointestinal tract ◼ heart failure H eart failure (HF) is a systemic disorder caused by the inability of the heart to accommodate the venous return and to maintain sufficient cardiac output to meet the body's metabolic needs.1 These hemodynamic perturbations result in a state of systemic inflammation with well-described and well-studied consequences in a variety of other organ systems, including the renal, cerebral, musculoskeletal, and immune systems. In contrast, the gastrointestinal and hepatic systems have received less attention, although gastrointestinal symptoms are common. With increasing clinical efforts to resuscitate the advanced HF patient, a greater appreciation and a better understanding of the gastrointestinal and hepatic manifestations of HF are needed. 2,3With some notable exceptions, gastrointestinal and hepatic involvement in heart disease has historically received little attention from cardiologists. 4 Mechanisms of gastrointestinal and hepatic dysfunction remain poorly understood despite the common presence of gastrointestinal-related symptoms and the increased morbidity and mortality associated with their presence. The specific involvement of the gastrointestinal system in HF results in a bidirectional relationship that has been called the cardiointestinal syndrome.5 For example, the systemic volume overload characteristic of HF is generally accompanied by concomitant gut edema, which can lead to bacterial translocation into the systemic circulation. Consequent monocyte activation and excessive cytokine release result in systemic inflammation, increased symptoms, and disease progression. In this review, we describe the current state of understanding of the gastrointestinal and hepatic systems in HF. Although nutritional status is also relevant in this discussion, we refer the reader to other excellent reviews of nutritional aspects of chronic disease. 7,8The Gut in HF Gastrointestinal System as a Venous ReservoirStudies of implantable hemodynamic monitors to manage HF patients document that acute decompensated HF was not associ...

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“…that thorough analysis is required before using human albumin in a direct association and as the firstchoice treatment. 7,24,34 The possible positive impact within clinical practice from using a combination of human albumin and furosemide among patients with edema is not associated with correction of hypovolemia. There is agreement that one possible explanation for the Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…17 Some studies have shown that human albumin enhances the effect of diuretics, 13,[18][19][20][21] while other studies have failed to show any difference in the results from comparisons between ways of using diuretics: on a stand-alone basis or in association with albumin. 17,[22][23][24][25] Some other studies have contraindicated this combination of human albumin and diuretics for treating edema in NS, 26 while yet others have shown benefit from stand-alone use of albumin.…”

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confidence: 99%

Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study

et al. 2017

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CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics.The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires.RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION:The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines. RESUMO

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Effect of Albumin on Diuretic Response to Furosemide in Patients With Hypoalbuminemia

Cited by 23 publications

References 11 publications

Albumin administration in the acutely ill: what is new and where next?

Albumin administration in the acutely ill: what is new and where next?

Gastrointestinal and Liver Issues in Heart Failure

Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study

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