Practice Patterns and Outcomes Associated with Intravenous Albumin in Patients with Cirrhosis and Acute Kidney Injury.

BACKGROUND & AIMS Guidelines recommend albumin as the plasma-expander of choice for acute kidney injury (AKI) in cirrhosis. However, the impact of these recommendations on patient outcomes remains unclear. We aimed to determine practice-patterns and outcomes associated with albumin use in a large, nationwide-US cohort of hospitalized cirrhotics with AKI. METHODS A retrospective cohort study was performed in hospitalized cirrhotics with AKI using Cerner-Health-Facts database from 1/2009-03/2018. 6,786 were included for analysis on albumin-practice-patterns, and 4,126 had available outcomes data. Propensity-score-adjusted model was used to determine the association between albumin use, AKI-recovery, and in-hospital survival. RESULTS Median age was 61-years (60% male, 70% white), median serum-creatinine was 1.8 mg/dL, and median Model for End-stage Liver Disease Sodium (MELD-Na) score was 24. Albumin was given to 35% of patients, of which 50% received albumin within 48-hours of AKI-onset, and 17% received appropriate weight-based dosing. Albumin was used more frequently in patients with advanced complications of cirrhosis, higher MELD-Na scores, and patients admitted to urban-teaching hospitals. After propensity-matching and multivariable adjustment, albumin use was not associated with AKI-recovery [Odds-ratio (OR) 0.70, 95% confidence-interval (CI): 0.59-1.07, p=0.130] or in-hospital survival [OR 0.76 (95%CI: 0.46-1.25), p=0.280], compared to crystalloids. Findings were unchanged in subgroup analyses of patients with varying cirrhosis complications and disease severity. CONCLUSIONS US hospitalized patients with cirrhosis and AKI frequently do not receive intravenous albumin, and albumin use was not associated with improved clinical outcomes. Prospective randomized trials are direly needed to evaluate the impact of albumin in cirrhotics with AKI.