A Comparison of Outcomes of Standard Weight-Based and Capped Doses of Albumin for Spontaneous Bacterial Peritonitis

Background: Albumin is recommended in the management of patients with spontaneous bacterial peritonitis (SBP) to reduce rates of renal injury and mortality. Current guideline recommendations suggest an intravenous albumin dosing regimen of 1.5 g/kg on day 1 and 1 g/kg on day 3, although a maximum dosing strategy is not well-defined. Objective: The purpose of this study was to evaluate differences in renal injury for patients with SBP treated with a capped dose less than or equal to 100 g vs a weight-based dose greater than 100 g. Methods: A retrospective analysis was conducted at a single academic medical center for patients with a diagnosis of cirrhosis treated with albumin for SBP. The primary outcome examined rates of acute renal injury at 5 days between patients treated with capped dose vs weight-based doses of intravenous albumin. Secondary outcomes included resolution of SBP by day 5, death by day 5, death by day 30, and change in serum creatinine from day 0 to day 5. Results: In total, 258 patient encounters were analyzed, with 154 included in this study. There were 70 encounters encompassing the capped dose and 84 in the non-capped. Acute renal injury at day 5 was observed in 10% (n = 7) of the capped dosed group and 6% (n = 5) of the non-capped group ( P = 0.381). Conclusion and Relevance: This study did not show a significant difference in outcomes associated with a capped albumin dose at 100 g for SBP. Application of these data may aid in reducing health system and patient costs.