Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial

Background/Aims: Diuretic treatment of ascites could result in intravascula r volume depletion, electrolyte imbalance and renal impairment. We investig ated whether intravascular volume expansion with albumin exert beneficial e ffects in cirrhosis with ascites. Methods: In protocol 1, 126 cirrhotic inpatients in whom ascites was not re lieved following bed rest and a low-sodium diet, were randomly assigned to receive diuretics (group A) or diuretics plus albumin, 12.5 g/ day (group B ). In protocol 2, group A patients continued to receive diuretics and group B diuretics plus albumin (25 g/week) as outpatients and were followed up f or 3 years. End points were: disappearance of ascites, duration of hospital stay (protocol 1), recurrence of ascites, hospital readmission and surviva l (protocol 2). Results: The cumulative rate of response to diuretic treatment of ascites w as higher (p<0.05) and hospital stay was shorter (20+/-1 versus 24+/-2 days , p<0.05) in group B than in group A patients. After discharge, group B pat ients had a lower cumulative probability of developing ascites (19%, 56%, 6 9% versus 30%, 79% and 82% at 12, 24 and 36 months, p<0.02) and a lower pro bability of readmission to the hospital (15%, 56%, 69% versus 27%, 74% and 79%, respectively, p<0.02). Survival was similar in the two groups. Conclusions: Albumin is effective in improving the rate of response and pre venting recurrence of ascites in cirrhotic patients with ascites receiving diuretics. However, the cost/benefit ratio was favorable to albumin in prot ocol 1 but not in protocol 2.