Breaking the Myth: Does Albumin before the Furosemide Test Work?

Background: Acute kidney injury is a common complication in patients in the intensive care unit. It has multiple etiologies and risk factors that lead to adverse clinical outcomes, chronic kidney disease or death. Patients undergoing the furosemide stress test are classified as responders or non-responders based on whether their urine output is greater than 200 ml or not within 2 hours after the administration of furosemide. We consider that hypoalbuminemia could be an important factor for the diuretic response, as 95% of furosemide binds to plasma proteins. Therefore, we sought to evaluate the effectiveness of the Furosemide Stress Test in patients with hypoalbuminemia. Methods: This is a prospective quasi-experimental study. Informed consent was obtained, with prior authorization from the ethics committee. Patients were obtained from the intensive care unit of the Dr.José Eleuterio González University Hospital with KDIGO 1 and 2 AKI and serum albumin less than 3 g/dL. A bolus of furosemide was administered at a dose calculated to be 1-1.5 mg/kg in a single dose to patients without a prior diagnosis of kidney disease and without clinical signs of hypovolemia. Results: A total of 37 patients were enrolled, aged between 19 and 77 years, of which 45% had diabetes mellitus,40% had hypertension,51% were on at least one nephrotoxic medication, and 40% had sepsis as the cause of AKI. The mean albumin level was 1.8 g/dL. To evaluate the relationship between albumin levels and the use of furosemide, a correlation analysis was performed between albumin levels and the response to the furosemide stress test, which found no decrease in urinary response in patients with hypoalbuminemia. Conclusion: According to the population evaluated in our study, we determined that hypoalbuminemia does not decrease the response to the furosemide stress test. Therefore, we conclude that intravenous albumin should not be administered before furosemide. Funding: Government Support – Non-U.S.