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Forum » General Nephrology » AKI/ARF » Using lasix and albumin to increase diuresis

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Author	Topic: Using lasix and albumin to increase diuresis

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Using lasix and albumin to increase diuresis on: May 31, 2011, 14:08
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What are your thoughts about using lasix and albumin in patients who have acute renal failure + hypoalbuminemia who need to have fluid removed?

Internal Medicine Resident

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Re: Using lasix and albumin to increase diuresis on: May 31, 2011, 14:15
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In theory, co-administering albumin with loop diuretics should potentiate their effects. That's because loop diuretics must bind to albumin in order to be effectively delivered to the loop of Henle, where they can act on the 2Na-K-Cl receptor and potentiate a natriuresis.

Unfortunately, a number of studies have shown that the degree of natriuresis with loop diuretics + albumin (e.g., lasix + albumin) is not what one would expect. A study from South Korea showed a greater diuresis (loss of water) than natriuresis (loss of salt and water) when using the combination (Journal of Korean Medical Sciences 2001, Volume 16, pp. 448-54). Another study done in the US failed to show the promised natriuretic effects of lasix + albumin as well (Journal of the American Society of Nephrology 2001, Volume 12, pp. 1010-16).

In the end, if you've got a hypoalbuminemic patient who needs natriuresis, you might consider using a loop diuretic with a greater affinity for albumin. Torsemide and, especially, bumetanide, have greater affinities to albumin than lasix. As a result, a greater amount of the "administered" diuretic will reach the loop of Henle than lasix would.

Tejas Desai, MD

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