Impact of Albumin Dose Standardization in Large Volume Paracentesis

INTRODUCTION: To prevent paracentesis induced circulatory dysfunction, the American Association for the Study of Liver Disease recommends dosing albumin at 6–8 g/L of fluid removed after large volume paracentesis (LVP). In response to the albumin shortage in 2022, an albumin standardization protocol was implemented based on a study by Anderson et al., which was not associated with worse outcomes. METHODS: This IRB approved retrospective single center study included data from adult patients admitted at Ascension Via Christi Hospitals Wichita, Inc. who received albumin after LVP from 1/1/2021 to 4/30/2022 (PRE-AS) and 1/1/2023 to 4/30/2024 (POST-AS), respectively. Select exclusion criteria included Scr >1.5 mg/dL and bilirubin ≥5 mg/dL with INR ≥1.5. The primary outcome was albumin dose in grams. Select secondary outcomes included acute kidney injury and hyponatremia. To meet a power of 80%, and alpha of 0.05, a sample size of 100 patients was needed. Chi-squared test or Fischer’s exact test was applied for discrete data, as appropriate. Student’s t-test or Mann-Whitney U test was applied for continuous data, as appropriate. RESULTS: Due to stringent exclusion criteria, only 35 patients were evaluated (PRE-AS, N = 14; POST-AS, N = 21). Neither primary outcome (p = 0.802) nor secondary outcomes reached statistical significance. CONCLUSIONS: Although underpowered, a statistically significant difference in albumin dose utilization was not observed. Future sufficiently powered studies should evaluate the non-inferiority of an albumin standardization protocol on the incidence of acute kidney injury and hyponatremia.