Effect of Albumin on Diuretic Response to Furosemide
Effect of Albumin on Diuretic Response to Furosemide
A total of 170 patients received continuous infusions of furosemide and 25% albumin during the study period. Thirty-six of these patients met the inclusion criteria of receiving continuous infusions of furosemide with and without 25% albumin for at least 6 hours. Of these, 5 patients had serum creatinine levels greater than 1.5 mg/dL and/or acute tubular necrosis. Therefore, data on 31 patients were included in the final analysis. Of the 31 patients, 17 initially received furosemide infusions; the other 14 patients initially received infusions of furosemide plus albumin.
A total of 19 patients (61%) were women, and the mean age was 54.3 years. The 3 most common underlying illnesses were cancer (36%), most often skin cancer; cardiovascular disease (23%); and liver disease (16%), mostly due to hepatitis C. A total of 26 patients (84%) had a ratio of PaO2 to fraction of inspired air less than 300. Other baseline characteristics are presented in Table 1.
Table 2 shows data for the patients who received furosemide alone and furosemide plus albumin. The infusion rate for furosemide was initiated at 2 to 5 mg/h and titrated in an attempt to achieve a urine output 50 to 100 mL/h greater than fluid intake. The infusion rate for 25% albumin was 8 or 10 mL/h in all but 3 patients (rates of 5 mL/h for 2 patients and 12 mL/h for 1 patient). The median initial furosemide dose was 4 mg/h in patients who received furosemide alone and 5 mg/h in patients who received furosemide plus albumin. Differences in furosemide dose between the 2 groups at 6 hours (P = .33) and 24 hours (P = .50) were not significant. At 48 hours, the patients who received furosemide plus albumin received more furosemide than did the patients who received furosemide alone (P = .04).
Urine output did not differ significantly between the 2 groups at 6, 24, or 48 hours (P values: .56, .42, and .94, respectively). Similarly, urine output did not differ significantly within the furosemide-alone group (P = .09) and the furosemide-plus-albumin group (P = .89) according to the order in which the infusions were administered as the primary end point. Additionally, net fluid loss did not differ significantly between the 2 groups at 6, 24, or 48 hours (P values: .42, .47, and .82, respectively).
Table 3 shows the relationship between urine output and independent variables according to simple regression analysis. Fluid intake was the only significant predictor of increased urine output for both the furosemide-alone group (P = .02; R = 0.27) and the furosemide-plus-albumin group (P = .004; R = 0.29) at 24 and 48 hours. In the patients given furosemide plus albumin, serum levels of albumin increased from 6 to 24 hours (mean, 2.0 g/dL [SD, 0.46] to 2.4 g/dL [SD, 0.47]; P = .04) and from 24 to 48 hours (mean, 2.4 g/dL [SD, 0.47] to 2.8 g/dL [SD, 0.45] P=.02), but only the 6 to 48 hour increase (mean, 2.0 g/dL [SD, 0.46] to 2.8 g/dL [SD, 0.45]; P < .001) was significant with post hoc adjustment of P values.
Results
A total of 170 patients received continuous infusions of furosemide and 25% albumin during the study period. Thirty-six of these patients met the inclusion criteria of receiving continuous infusions of furosemide with and without 25% albumin for at least 6 hours. Of these, 5 patients had serum creatinine levels greater than 1.5 mg/dL and/or acute tubular necrosis. Therefore, data on 31 patients were included in the final analysis. Of the 31 patients, 17 initially received furosemide infusions; the other 14 patients initially received infusions of furosemide plus albumin.
A total of 19 patients (61%) were women, and the mean age was 54.3 years. The 3 most common underlying illnesses were cancer (36%), most often skin cancer; cardiovascular disease (23%); and liver disease (16%), mostly due to hepatitis C. A total of 26 patients (84%) had a ratio of PaO2 to fraction of inspired air less than 300. Other baseline characteristics are presented in Table 1.
Table 2 shows data for the patients who received furosemide alone and furosemide plus albumin. The infusion rate for furosemide was initiated at 2 to 5 mg/h and titrated in an attempt to achieve a urine output 50 to 100 mL/h greater than fluid intake. The infusion rate for 25% albumin was 8 or 10 mL/h in all but 3 patients (rates of 5 mL/h for 2 patients and 12 mL/h for 1 patient). The median initial furosemide dose was 4 mg/h in patients who received furosemide alone and 5 mg/h in patients who received furosemide plus albumin. Differences in furosemide dose between the 2 groups at 6 hours (P = .33) and 24 hours (P = .50) were not significant. At 48 hours, the patients who received furosemide plus albumin received more furosemide than did the patients who received furosemide alone (P = .04).
Urine output did not differ significantly between the 2 groups at 6, 24, or 48 hours (P values: .56, .42, and .94, respectively). Similarly, urine output did not differ significantly within the furosemide-alone group (P = .09) and the furosemide-plus-albumin group (P = .89) according to the order in which the infusions were administered as the primary end point. Additionally, net fluid loss did not differ significantly between the 2 groups at 6, 24, or 48 hours (P values: .42, .47, and .82, respectively).
Table 3 shows the relationship between urine output and independent variables according to simple regression analysis. Fluid intake was the only significant predictor of increased urine output for both the furosemide-alone group (P = .02; R = 0.27) and the furosemide-plus-albumin group (P = .004; R = 0.29) at 24 and 48 hours. In the patients given furosemide plus albumin, serum levels of albumin increased from 6 to 24 hours (mean, 2.0 g/dL [SD, 0.46] to 2.4 g/dL [SD, 0.47]; P = .04) and from 24 to 48 hours (mean, 2.4 g/dL [SD, 0.47] to 2.8 g/dL [SD, 0.45] P=.02), but only the 6 to 48 hour increase (mean, 2.0 g/dL [SD, 0.46] to 2.8 g/dL [SD, 0.45]; P < .001) was significant with post hoc adjustment of P values.
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