AKI in cirrhosis can still show response to albumin after 24 hours, study finds
After 48 hours of albumin treatment, between 30% and 54% of patients with cirrhosis and acute kidney injury (AKI) had responded (depending on the definition of response). At 24 hours, only 25% to 38% had shown a response, a prospective study found.
Patients with cirrhosis and acute kidney injury (AKI) can take up to 48 hours to respond to albumin treatment, a study found.
The study included 127 prospectively recruited patients with cirrhosis and AKI in Germany who received volume expansion with albumin. The main outcome was response after 24 and 48 hours, defined as serum creatinine decreasing by more than 0.3 mg/dL, by at least 25%, or by one or more AKI stages; rates of liver transplantation, death, or initiation of hemodialysis were also assessed. The patients received a median albumin dose of 0.84 g/kg of body weight over 24 hours and 1.67 g/kg over 48 hours. Results were published by the Journal of Hepatology on March 19.
By 48 hours, 54.3% of patients responded to the albumin based on the 0.3-mg/dL criteria, while 30.7% met the 25% drop definition and 45.7% had a reduction in AKI stage. At 24 hours, the response rates were 38%, 24%, and 25%, respectively. The study also sought to identify which patients were most likely to benefit from continued albumin after the first day and found that, at 24 hours, a creatinine increase of at least 16% identified patients in whom further treatment with albumin was futile. The results also showed that only the third definition of response—AKI stage—predicted survival without dialysis or transplant.
The study authors noted that while guidelines from American and European liver societies recommend 48 hours of albumin, a recent update to the Acute Disease Quality Initiative-International Club of Ascites consensus guidelines suggested shortening the duration to 24 hours, primarily based on expert opinion.
“The findings of our current study argue strongly against a universal shortening of the duration of albumin treatment for each patient with AKI before initiating combination therapy with terlipressin since up to 40% of responders will do so between 24 and 48 hours,” the authors wrote, adding that “shortening the duration of volume expansion therapy may lead to overtreatment with terlipressin.”
Another important finding of the study was that only the third definition of response predicted the studied clinical outcomes. “Given that this was the only one associated with a better prognosis, it seems to be the most reasonable definition to be implemented in clinical practice,” the study authors said.
Finally, they pointed to the finding of similar response rates across AKI stages. “Importantly, even patients with AKI stage 3 showed a relevant response rate despite the fact that a higher baseline [serum creatinine] was associated with a poorer response rate. This emphasizes that an albumin challenge should not be dispensed [with] even in patients with higher-grade AKI if there are no signs of pulmonary volume overload,” they wrote.