Intravenous albumin after outpatient paracentesis reduces risk of AKI hospitalization: A national cohort study

Background and Aims: Guidelines recommend intravenous (IV) albumin after large-volume paracentesis to prevent post-paracentesis circulatory dysfunction and acute kidney injury (AKI). However, real-world effects of albumin on paracentesis outcomes in outpatient settings are understudied. We aimed to address this using national data from a well-established cirrhosis cohort. Methodology: This was a retrospective cohort study of Veterans with cirrhosis undergoing outpatient paracentesis. Albumin administration and paracentesis volumes were extracted, in addition to hospitalization for AKI within 7 days of outpatient paracentesis. Mixed-effects logistic regression identified factors associated with albumin administration and the association between albumin and incident AKI hospitalization. Results: Among 9,467 patients who received 56,941 outpatient paracentesis procedures, IV albumin was used 17% of the time. Use was higher with MELD-Na (OR 1.02, 95% CI 1.02-1.03, p <0.001), lower eGFR (OR 3.06 for <30 vs. ≥90 mL/min/1.73 m², 95% CI 2.64-3.54, p <0.001), and hepatic encephalopathy (OR 1.22, 95% CI 1.13-1.33, p <0.001). Albumin administration was associated with lower odds of AKI-related hospitalizations (OR 0.66, 95% CI 0.54–0.81, p <0.001) with greater effect observed in patients with lower eGFR (interaction p -value=0.03). In a subcohort of 48,401 procedures with available dosing information, higher-dose albumin (≥6-8 g/L removed) was associated with lower odds AKI hospitalization (OR 0.36, 95% CI 0.20-0.64, p =0.001) with similar associations noted irrespective of paracentesis volume. Conclusion: Albumin administration after outpatient paracentesis was associated with a reduced risk of hospitalization with AKI, with greater effect at lower eGFRs. Strategies that tailor albumin administration based on intravascular volume and hemodynamics should be prospectively tested.