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2015 ; 3
(3
): 216-21
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
The efficacy and safety profile of albumin administration for patients with
cirrhosis at high risk of hepatorenal syndrome is dose dependent
#MMPMID26178624
Afinogenova Y
; Tapper EB
Gastroenterol Rep (Oxf)
2015[Aug]; 3
(3
): 216-21
PMID26178624
show ga
BACKGROUND: Albumin is a critical component in the standard therapeutic approach
to acute renal failure (ARF) and spontaneous bacterial peritonitis (SBP) in the
setting of ascites. However, data regarding the safety and minimum effective dose
are limited. METHODS: We conducted a retrospective review of patients with
decompensated cirrhosis who received albumin within the first 48 hours of
hospitalization at Beth Israel Deaconess Medical Center between 2010 and 2013.
Outcomes included 90-day risk of death or transplantation (primary) and
(secondary) complications of albumin infusion (length of stay (LOS) and need for
critical care)), all adjusted for comorbidity and severity of illness. RESULTS:
We included 169 patients with ARF and 88 patients with SBP. The optimal doses of
albumin for a survival benefit were found to be 87.5?g and 100?g in the ARF and
SBP cohorts, respectively. The odds ratio (OR) for the 90-day risk of death or
liver transplantation associated with the optimal loading dose was 0.36 (95% CI:
0.17-0.76, P?=?0.008) and 0.28 (95% CI: 0.07-0.97, P?=?0.04) for the ARF and SBP
cohorts, respectively. This effect persisted for patients with ARF who had
neither hepatorenal syndrome (HRS) nor SBP (OR: 0.13, 95% CI: 0.007-0.79,
P?=?0.02). LOS (beta coefficient per log albumin dose: 1.69; 95% CI: 0.14-3.24,
P?=?0.03) and risk of critical care (OR/g albumin: 1.03; 95% CI: 1.01-1.05,
P?=?0.01) were also dose dependent. CONCLUSION: Albumin has a dose-dependent
effect on both survival and complications in patients with cirrhosis with ARF
(HRS and otherwise) and/or SBP.