(1416) Impact of 25% Albumin on Vasopressor Requirements in Critically Ill Patients Receiving CRRT

Introduction: Critically ill patients commonly develop acute kidney injury requiring continuous renal replacement therapy (CRRT). Patients on CRRT may experience hypotension necessitating vasopressors, crystalloid or colloid fluid replacement, or ultrafiltration (UF) rate adjustment. There is limited literature on the impact of 25% albumin on vasopressor requirements for critically ill patients requiring CRRT.

Methods: This single-center, retrospective, intrapatient comparator study included all adults admitted to the Duke University Hospital CTICU or SICU from September 2021 to September 2023, who received 25% albumin while on CRRT and vasopressors. The primary endpoint was the absolute change in vasopressor dosage from 48 hours before to 48 hours after the first albumin administration in norepinephrine equivalents (NEE, mcg/kg/min). Secondary endpoints included percent change in vasopressor dosage, mean arterial pressure (MAP), UF rate, and 48-hour fluid balance. To adjust for confounding variables, a multivariable interrupted time series model examined the association between albumin and vasopressor requirements over time.

Results: Sixty-five patients were included. The median absolute change in mean vasopressor dosage from 48 hours pre- to 48 hours post-albumin was -0.003 mcg/kg/min (p=0.7), with a percentage change of -3.4% (IQR -31.2, 37.9). MAP remained similar in the 48 hours pre- and post-albumin. From 48 hours pre-albumin to 48 hours post-albumin, there was an absolute change in the 48-hour fluid balance and UF rate of -482.4 mL/48 hr (IQR -3125.6, 1202.8) and 13.4 mL/hr (IQR -22.1, 50), respectively. In the multivariable regression analysis, there was a 0.0038 mcg/kg/min increase in NEE for every 4-hour increase in time in the 48 hours prior to albumin (p=0.0148). After albumin, there was a 0.0033 mcg/kg/min decrease in NEE for every 4-hour increase in time (p=0.029).

Conclusions: In critically ill patients receiving 25% albumin while requiring CRRT and concurrent vasopressors, there was no difference in mean vasopressor requirements in the 48 hours before compared to the 48 hours after albumin. However, multivariable regression demonstrated a significant association between albumin administration and reduced vasopressor requirements during the 48-hour period following albumin administration.