(929) Albumin Levels and Impact on Loop Diuretic and Albumin Coadministration in Heart Failure

Introduction: Management of heart failure (HF) requires the use of loop diuretics to relieve congestion and improve symptoms. When loop diuretics alone fail to induce adequate diuresis, albumin has been proposed to enhance loop diuretic delivery to its action site and promote intravascular redistribution of fluid for excretion by the kidneys. Despite the theoretical benefits of albumin, studies suggesting its benefit in HF are scarce and the co-administration of loop diuretics and albumin remains controversial.

Methods: This retrospective, observational study evaluated HF patients 18 years or older who received concomitant intravenous loop diuretic and albumin administration. Patients were excluded if they received renal replacement, were discharged within 24 hours of therapy, or received oral or continuous infusion loop diuretics. A multivariable regression analysis was performed to determine the association of initial albumin level (gm/dL) with 72-hour urine output (mL). The primary endpoint was urine output within the first 72-hours of co-administration.

Results: 276 patients were included for analysis. Most patients were stage C or D (91.7%), NYHA Class III or IV (83.7%) and had heart failure with reduced ejection fraction (83%). The mean 72 hour albumin and loop dose in furosemide equivalents were 79.2 gm and 194.3 mg, respectively. There was no association between initial serum albumin level and 72-hour urine output (coefficient -623.1, 95% CI -1558.6, 312.4; p=0.191) or weight difference at 72-hours (coefficient -1.0, 95% CI -2.4, 0.3; p=0.131). Thiazide diuretic use and higher loop doses were associated with higher urine output, while increased serum creatinine was associated with lower urine output. Albumin administration was not associated with increased urine output.

Conclusions: Baseline serum albumin level was not associated with increased 72-hour urine output in hospitalized HF patients who received combination intravenous albumin and loop diuretic therapy. Concomitant thiazide diuretic use and increasing loop diuretic doses were associated with increased 72-hour urine output. Given the lack of comparator groups in our study, larger randomized controlled trials should be done to provide a definitive role for albumin to enhance diuresis in HF patients on intravenous loop diuretics.