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Purpose: Hypoalbuminemia is believed to decrease diuretic effectiveness and contribute to diuretic resistance that is observed in patients with nephrotic syndrome. Hypoalbuminemia is also seen in patients with acute decompensated heart failure (ADHF). However, the role of hypoalbuminemia on the effectiveness of continuous infusion diuretics in patients with ADHF is not known.
Methods: To evaluate hypoalbuminemia (albumin ≤ 3 g/dL) and diuretic effectiveness we performed a retrospective study in 162 patients admitted to a tertiary care center for treatment of ADHF over a 3 year period. All patients received continuous infusion diuretic for at least a 2 day time period.
Results: A total of 33 patients were determined to have hypoalbuminemia with a mean albumin level of 2.7 ± 0.3 mg/dL. In comparison, the mean albumin level of in the control group was 3.7 ± 0.4 mg/dL (p < 0.01). Average net urine output over two day study period were similar between patients with and without hypoalbuminemia (-1462 ± 1734 mL vs -1233 ± 1560 mL, p =0.46 , respectively). In addition, average diuretic dose (furosemide equivalent/24hrs) were similar between the two groups (681 ± 800 mg vs 788 ± 670 mg, p= 0.35, respectively) as was baseline serum creatinine (1.6 ± 0.6 mg/dL vs 1.6 ± 0.6 mg/dL, p= 0.5, respectively).
Conclusion: Overall, hypoalbuminemia did not decrease diuretic effectiveness as measured by net urine output in patients receiving continuous infusion diuretics for the treatment of ADHF.