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Hypoalbuminemia increases the time to euvolemia in heart failure patients
Session:
Posters (Sessão 3 - Écran 5) - Insuficiência Cardíaca - Clínica
Speaker:
Inês Fialho
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Inês Fialho; Mariana Passos; Filipa Gerardo; Joana Lima Lopes; Carolina Mateus; Inês Miranda; Marco Beringuilho; Ana Oliveira Soares; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Background: </span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Loop diuretics are the cornerstone of decongestive therapy in heart failure (HF) patients. Loop diuretics are delivered to the kidney with >95% albumin bound, then serum albumin levels could influence loop diuretics pharmacokinetics and efficiency.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Objectives: </span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">To evaluate the effect of serum albumin levels on time to euvolemia in HF patients.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Methods: </span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Retrospective cohort registry<strong> </strong>of patients hospitalized due to acute HF in a single center between January 2021 and September 2022. The time to euvolemic state was </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">inferred by the time needed to switch from intravenous to oral furosemide. Hypoalbuminemia was defined as serum albumin level less than 3.4 mg/dL. Demographics, serum creatinine levels at admission and throughout hospitalization, serum albumin levels, NTproBNP at admission and time to switch to oral furosemide were recorded.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Results: </span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">one hundred and fifty-three<strong> </strong>patients were included, 63.4% males (n=97), mean age of 65.7 </span></span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"> 13.0 years. The median (IQR) time to switch to oral furosemide was 5 (3 – 8) days and the mean serum albumin level was 3.84 </span></span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">0.60 mg/dL. The median (IQR) serum creatinine at admission was 1.24 (0.93 – 1.69) mg/dL and the median maximum serum creatinine throughout hospitalization was 1.50 (1.08 – 2.20) mg/dL. Patients with hypoalbuminemia presented longer time to switch to oral furosemide (8 [5 – 14] vs 4 [3 – 6] days, p<0.001), taking more time to achieve euvolemia (Mantel-cox log rank p<0.001, Figure 1). Serum creatinine level (1.48 [1.05 – 2.20] mg/dL vs 1.78 [1.29 – 3.03] mg/dL, p=0.105) and NTproBNP level (6,482 [2,871 – 14,874] pg/mL vs 9,804 [4,083 – 23,105] pg/mL, p=0.145) were not significantly different between the two groups (patients with normal albumin levels and patients with hypoalbuminemia, respectively).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Conclusions: </span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Hypoalbuminemia is associated with a longer time to switch to oral furosemide, independent of kidney function or severity of congestion. Prospective studies are needed to assess if albumin replacement therapy leads to a more effective decongestion in HF patients.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Figure 1</span></strong><span style="font-size:11pt"> - </span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Time to switch to oral furosemide (days) in patients with normal (blue) and low serum albumin (red) (Cox-Mantel log rank p<0.001).</span></span></span></span></span></p>
Slides
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