Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 29;9(10):e0760.
doi: 10.1097/HC9.0000000000000760. eCollection 2025 Oct 1.

Albumin prevents kidney injury but is underutilized in a cohort of patients undergoing large-volume paracentesis

Rahul Rajkumar  1 , Nikki Duong  2 , W Ray Kim  3 , Elisabet Viayna  4 , Thomas Ardiles  5 , Cristina Coll-Ortega  4 , E Anne Davis  6 , Jonathan Lilley  1 , Xuan Zhang  1 , Nisha Wadhwani  1 , Kunal Lodaya  1
Affiliations

Albumin prevents kidney injury but is underutilized in a cohort of patients undergoing large-volume paracentesis

Rahul Rajkumar et al. Hepatol Commun. .

Abstract

Background: Cirrhosis and cirrhosis-related deaths have risen in the United States in recent years. Ascites is a common complication, often requiring large-volume paracentesis (LVP). The American Association for the Study of Liver Diseases (AASLD) recommends the administration of albumin in conjunction with LVP to prevent further complications of cirrhosis. Emerging research in cirrhosis care reveals significant variations in outcomes among different demographics. Therefore, we assessed the use of guideline-adherent albumin and outcomes in U.S. patients undergoing LVPs, particularly at the intersection of race, ethnicity, socioeconomic disparities, and cirrhosis.

Methods: This retrospective study utilized Cerner Real World Data to identify adults with cirrhosis and ascites undergoing LVP between January 2016 and June 2022. We assessed albumin utilization patterns across racial and ethnic groups and payor types, and their overall impact on acute kidney injury (AKI)-related hospitalization using an adjusted generalized linear model (aGLM).

Results: We identified 736 patients: 301 in the LVP + albumin group and 435 in the LVP-only group. Despite clinical recommendations, only 41% undergoing LVPs received albumin. White patients and commercially insured patients received albumin at higher rates (p=0.042 and p=0.009, respectively). The overall rate of AKI-related admissions within the 30-day post-procedure period was 26%. However, patients who received albumin during LVP had a 36% lower risk of short-term AKI-related hospitalization (OR: 0.64; p=0.03).

Conclusions: These findings indicate a potential for broader albumin utilization in U.S. patients with refractory ascites undergoing repeated LVPs to reduce AKI-related admissions.

Keywords: decompensated cirrhosis; pharmacoequity; real-world evidence; social determinants of health; structural racism.

PubMed Disclaimer

Conflict of interest statement

Elisabet Viayna and Cristina Coll-Ortega are employees of Grifols. Thomas Ardiles is an employee of Grifols, SSNA. W. Ray Kim serves as an advisor to Grifols SSNA and has contributed to research supported by Grifols SSNA. He received no personal financial remuneration for this study. At the time of the study, E. Anne Davis was an employee of Grifols, S.A. Rahul Rajkumar, Jonathan Lilley, Xuan Zhang, Nisha Wadhwani and Kunal Lodaya are employees of Boston Strategic Partners. Nikki Duong has no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Patient flowchart. *Within 24 hours of admission and ≤ discharge time. #Exclusionary services, for example, cardiology, obstetrics, and neurology. Abbreviations: LVP, Large-volume paracentesis.
FIGURE 2
FIGURE 2
Albumin utilization across (A) races and ethnicities and (B) payor types. *Includes TRICARE, Government, and Charity payor types.
FIGURE 3
FIGURE 3
Adjusted generalized linear model for AKI-related inpatient admissions within 30 days of index LVP. **p<0.01 and *p<0.05. Adjusted for age, sex, race and ethnicity, payor type, U.S. region, hospital bed size, care setting and CCI. For race: other includes Native American or Pacific Islander, Asian, Mixed, and Other races. For Payor group: other includes TRICARE, Government, and Charity payor types. Abbreviations: AKI, acute kidney injury; CCI, Charlson comorbidity index; LVP, large-volume paracentesis.
See this image and copyright information in PMC

References

    1. Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States: A population-based study. J Clin Gastroenterol. 2015;49:690–696. - PubMed
    1. Spiewak T, Taefi A, Patel S, Li CS, Chak E. Racial disparities of Black Americans hospitalized for decompensated liver cirrhosis. BMC Gastroenterol. 2020;20:245. - PMC - PubMed
    1. Talwalkar JA. Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis. Gastroenterology. 2006;130:1005–1007. - PubMed
    1. Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330:337–342. - PubMed
    1. Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling SC, Nadim MK, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74:1014–1048. - PubMed

MeSH terms