Targeted albumin infusions increase serum sodium in cirrhosis

Targeted human albumin solution increased serum sodium in hospitalized patients with cirrhosis and hyponatremia, according to prospective data presented at the International Liver Congress.

“A large U.S. retrospective cohort study indicated that patients treated with human albumin solution (HAS) saw greater resolution of hyponatremia. However, the comparator group received no albumin and many hospitalized decompensated cirrhosis patients expected to develop spontaneous bacterial peritonitis or renal dysfunction” Alastair O’Brien, PhD, UCL Institute for Liver and Digestive Health, said. “We considered that a more appropriate comparison would include patients in [whom] albumin was prescribed for these well-established reasons to determine whether albumin infusions specifically benefit hyponatremia.”

In an open-label, parallel-group sub study from the ATTIRE trial, 777 patients with decompensated cirrhosis with hyponatremia received targeted 20% HAS infusions to raise albumin greater than 30 g/L for 14 days. Researchers analyzed the interaction between targeted albumin and standard care; the composite primary endpoint was new infection, kidney disfunction or death on day 3 through day 15.

Patients with baseline sodium levels less than 130 mmol/L (n = 206) received either 239.4 g of albumin or 123.2 g standard care; randomized albumin correlated with a 1.07 mmol/L (95% CI, 1.04-2.51) increase in sodium at day 5. Researchers noted no interaction between sodium category and treatment group nor renal dysfunction and death.

“Targeted albumin infusions raise serum sodium in hospitalized decompensated cirrhosis patients with hyponatremia at baseline but does not improve short-term outcome compared with standard of care,” O’Brien concluded. “These prospective data from our completed randomized trial do not support extending albumin use for treatment of hyponatremia in decompensated cirrhosis.”