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The Impact of Albumin Use on Resolution of Hyponatremia in Hospitalized Patients With Cirrhosis

Bajaj, Jasmohan S., MD1; Tandon, Puneeta, MD2; O'Leary, Jacqueline G., MD3; Biggins, Scott W., MD4,5; Wong, Florence, MD6; Kamath, Patrick S., MD7; Garcia-Tsao, Guadalupe, MD8; Maliakkal, Benedict, MD9,10; Lai, Jennifer C., MD11; Fallon, Michael, MD12,13; Thuluvath, Paul, MD14; Vargas, Hugo E., MD15; Subramanian, Ram M., MD16; Thacker, Leroy R., PhD1; Reddy, Rajender K., MD17

American Journal of Gastroenterology: September 2018 - Volume 113 - Issue 9 - p 1339
doi: 10.1038/s41395-018-0119-3

OBJECTIVES: Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia.

METHODS: Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥ 135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models.

RESULTS: Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%,p= 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%,p= 0.0057, OR: 1.50 95% CI: 1.13–2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR.

CONCLUSION Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.

1Virginia Commonwealth university and McGuire VA Medical Center, Richmond, VA, uSA. 2university of Alberta, Edmonton, AB, Canada. 3Dallas VA Medical Center and Baylor University Medical Center, Dallas, TX, USA. 4University of Washington, Seattle, WA, USA. 5University of Denver, Colorado, CO, USA. 6University of Toronto, Toronto, ON, Canada. 7Mayo Clinic, Rochester, MN, USA. 8Yale University Medical Center, West Haven, CT, USA. 9University of Tennessee, Memphis, TN, USA. 10University of Rochester, Rochester, NY, USA. 11University of California, San Francisco, CA, USA. 12University of Arizona, Phoenix, AZ, USA. 13University of Texas, Houston, TX, USA. 14Mercy Medical Center, Baltimore, MD, USA. 15Mayo Clinic, Scottsdale, AZ, USA. 16Emory University Medical Center, Atlanta, GA, USA. 17University of Pennsylvania, Philadelphia, PA, USA.

Correspondence: J.S.B. (email:

SUPPLEMENTARY MATERIAL accompanies this paper at

Received 29 January 2018; accepted 23 April 2018; Published online 8 June 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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