Efficacy and safety of human albumin combined with furosemide in acute decompensated heart failure with hepatic dysfunction

BACKGROUND: Congestion is the most common clinical presentation on admission of patients with acute decompensated heart failure (ADHF). Finding effective ways to alleviate congestion has become a pivotal management step. This study sought to investigate the efficacy and safety of intravenous (IV) albumin use in conjunction with furosemide in patients hospitalized for ADHF with hepatic dysfunction in terms of subjective regression of congestion symptoms and worsening renal function (WRF). METHODS: This prospective, open-label, randomized-pragmatic trial recruited 241 patients with hepatic dysfunction hospitalized for ADHF. Patients (78 years, 54% female) were assigned to receive IV albumin with furosemide or IV furosemide alone. The coprimary study endpoints were patients' global assessment of symptoms (PGAS) score, quantified as the area under the curve (AUC) of the score on a visual analog scale, and the change in creatinine levels over 72 h from admission. RESULTS: 3767 vs. 3457 points; P < 0.001) and a milder increase in creatinine levels (0.07 vs. 0.18 mg/dL; P = 0.045) than the IV furosemide group. The length of stay was 1 day shorter (4 vs. 5 days; P < 0.001) and the incidence of WRF was lower (25% vs 38%; P = 0.037) in the experimental treatment group. CONCLUSIONS: In this hypothesis generating study, among patients with ADHF and hepatic dysfunction, concomitant use of IV albumin and furosemide for the first 72 h resulted in a significant improvement in subjective perception symptoms of decongestion and a milder increase in creatinine levels than IV furosemide alone.