Scientific Poster Session III - Original Research

Original Research
  Monday, November 13, 2023
  01:00 PM–02:30 PM

Abstract

Introduction: Critically ill patients commonly develop volume overload after receiving large amounts of intravenous (IV) fluids to achieve hemodynamic stability. Volume overload is associated with increased intensive care unit (ICU) length of stay (LOS) and mortality. Strategies to deresuscitate patients once they are no longer requiring fluids decrease these poor outcomes. Hyperoncotic albumin could theoretically increase the effectiveness of loop diuretics in hypoalbuminemic patients.

Research Question or Hypothesis: The goal of this study was to determine if hyperoncotic albumin combined with loop diuretics enhances urine output compared to loop diuretic monotherapy in patients with hypoalbuminemia.

Study Design: This study was a single center retrospective cohort from September 2020 through August 2022.

Methods: Included patients were =19 years old, admitted to an ICU, received an IV loop diuretic, and had hypoalbuminemia. Patients who received hyperoncotic albumin or an IV loop diuretic for an alternative indication, were pregnant, received any renal replacement therapy concurrently with the loop diuretic or albumin, or did not receive the initial loop diuretic dose within 1 hour before or 4 hours after albumin receipt in the combination therapy group were excluded. The primary outcome was 24-hour urine output (mL/kg/hr). Secondary outcomes included 24-hour net fluid balance, mortality, ICU LOS, and hospital LOS. Nominal data was analyzed using the chi-squared test and continuous data using an unpaired t-test or Wilcoxon rank sum.

Results: One hundred twenty-one patients were analyzed. Patients who received combination therapy had higher UOP (1.81 vs 1.43 mL/kg/hr) (p = 0.026). There was no difference in net 24-hour volume status, ICU or hospital LOS, or mortality. Albumin administration was not associated with higher urine output in patients with lower albumin levels.

Conclusion: Patients receiving albumin and loop diuretic combination therapy had increased urine output, likely influenced by increased intake, but did not have improved clinical outcomes.

Presenting Author

Sarah Blackwell PharmD

Authors

John Michael Herndon PharmD
Princeton Baptist Medical Center

Gregory Taylor PharmD
Princeton Baptist Medical Center