Impact of 25% Albumin on Vasopressor Requirements in Critically Ill Patients Receiving Continuous Renal Replacement Therapy.

BACKGROUND: Critically ill patients receiving continuous renal replacement therapy (CRRT) commonly experience hypotension necessitating fluids, ultrafiltration (UF) adjustment, or vasopressors. There is limited evidence evaluating 25% albumin on vasopressor requirements in this population. OBJECTIVE: To evaluate the impact of 25% albumin on vasopressor requirements for critically ill patients requiring CRRT. METHODS: This single-center, retrospective, intrapatient comparator study included adults admitted to the Cardiothoracic Surgery Intensive Care Unit (CTICU) who received 25% albumin intravenously every 6 or 8 hours for ≥2 consecutive doses while on CRRT and vasopressors. The primary endpoint was the absolute change in average vasopressor dosage from 48 hours before to 48 hours after the first albumin administration in norepinephrine equivalents (NEE, mcg/kg/min). A multivariable interrupted time series model was conducted. Notable secondary endpoints included absolute change in UF rate and 48-hour fluid balance. RESULTS: Of 252 patients reviewed, 60 were included. The median absolute change in average vasopressor dosage from 48 hours prealbumin to 48 hours postalbumin was -0.005 mcg/kg/min (Q1: -0.035, Q3: 0.021, P = 0.24), with a median percentage change in average dosage of -9.5% (Q1: -33.2, Q3: 34.4). The multivariable regression analysis reported a 0.0038 mcg/kg/min increase in vasopressor dosage (P = 0.02) and a 0.0044 mcg/kg/min decrease in vasopressor dosage (P = 0.001) for every 4-hour increase in time in the 48 hours before and after albumin, respectively. From 48 hours prealbumin to 48 hours postalbumin, UF rate increased numerically (10.6 mL/hr [interquartile range (IQR) -24.0, 49.8]), and 48-hour fluid balance decreased numerically (-467.4 mL/48 hr [IQR -3124.5, 1306.3]). CONCLUSION AND RELEVANCE: In CTICU patients receiving CRRT and vasopressors, 25% albumin resulted in no statistically significant difference in average vasopressor requirements in the 48 hours prealbumin compared to the 48 hours postalbumin in the unadjusted model. However, multivariable regression demonstrated a significant association between albumin administration and reduced vasopressors during the 48-hour period following albumin.

Duke Scholars

Author Lexie Zidanyue Yang  

Author Daniel Lee Gilstrap Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Alaattin Erkanli Biostatistics & Bioinformatics, Division of Biostatistics

Author Jerrold Henry Levy Anesthesiology, Cardiothoracic

Author Cory Joseph Vatsaas Trauma, Acute, and Critical Care Surgery