Intravenous albumin after outpatient paracentesis reduces the risk of AKI hospitalization: A national cohort study

BACKGROUND AND AIMS: Guidelines recommend i.v. albumin after large-volume paracentesis to prevent postparacentesis circulatory dysfunction and acute kidney injury (AKI). However, real-world effects of albumin on paracentesis outcomes in outpatient settings are understudied. We aimed to address this using national data from a well-established cirrhosis cohort. APPROACH AND RESULTS: This was a retrospective cohort study of Veterans with cirrhosis undergoing outpatient paracentesis. Albumin administration and paracentesis volumes were extracted, in addition to hospitalization for AKI within 7 days of outpatient paracentesis. Mixed-effects logistic regression identified factors associated with albumin administration and the association between albumin and incident AKI hospitalization. Among 9467 patients who received 56,941 outpatient paracentesis procedures, i.v. albumin was used 17% of the time. The use was higher with Model for End-Stage Liver Disease-Sodium; (OR: 1.02, 95% CI: 1.02-1.03, p<0.001), lower estimated glomerular filtration rate (OR: 3.06 for <30 vs. ≥90 mL/min/1.73 m2, 95% CI: 2.64-3.54, p<0.001), and HE (OR: 1.22, 95% CI: 1.13-1.33, p<0.001). Albumin administration was associated with lower odds of AKI-related hospitalizations (OR: 0.66, 95% CI: 0.54-0.81, p<0.001), with a greater effect observed in patients with lower estimated glomerular filtration rate (interaction p value=0.03). In a subcohort of 48,401 procedures with available dosing information, higher-dose albumin (≥6-8 g/L removed) was associated with lower odds of AKI hospitalization (OR:: 0.36, 95% CI:: 0.20-0.64, p=0.001) with similar associations noted irrespective of paracentesis volume. CONCLUSIONS: Albumin administration after outpatient paracentesis was associated with a reduced risk of hospitalization with AKI, with a greater effect at lower estimated glomerular filtration rates. Strategies that tailor albumin administration based on intravascular volume and hemodynamics should be prospectively tested.