Effects of albumin/furosemide mixtures on responses to furosemide in hypoalbuminemic patients

Hypoalbuminemic patients often have sufficient fluid accumulation to mandat e diuretic therapy but are often resistant to diuresis. Studies have sugges ted that hypoalbuminemia itself impairs delivery of effective amounts of di uretic agent into the urine, the site of action. Therefore, administration of mixtures of albumin and loop diuretics may enhance responses. Thirteen p atients with biopsy-proven cirrhosis and ascites (age, 51.2 +/- 8.1 yr; Chi ld-Pugh score, 8.5 +/- 1.0; serum albumin concentration, 3.0 +/- 0.6 g/dl) were studied in this randomized crossover study. Sodium balance was maintai ned throughout the study with a metabolic diet. All patients received spiro nolactone, but administration of all other diuretic agents was discontinued . Each patient received all of the following four treatments intravenously: (1) 40 mg of furosemide, (2) 25 g of albumin, (3) 40 mg of furosemide and 25 g of albumin premixed ex vivo, and (4) 40 mg of furosemide and 25 g of a lbumin infused simultaneously into different arms. Responses were assessed by measuring urinary sodium excretion and relating the urinary furosemide e xcretion rate to the sodium excretion rate. Additionally, the pharmacokinet ics of furosemide were assessed. Furosemide pharmacokinetics were similar f or all treatment arms. Albumin alone had negligible diuretic effects. Neith er albumin regimen increased the response to furosemide. Moreover, the rela tionship between the urinary furosemide excretion rate and the sodium excre tion rate was unaffected by albumin. In conclusion, albumin failed to enhan ce the diuretic effects of furosemide in cirrhotic patients with ascites. T herefore, the coadministration of albumin and furosemide for the treatment of cirrhosis, and likely other hypoalbuminemic conditions, should not be us ed clinically.