Effect of albumin infusion on preventing the deterioration of renal function in patients with spontaneous bacterial peritonitis

OBJECTIVE: To determine whether plasma volume expansion with albumin could prevent impairment of renal function and reduce mortality in cirrhotic patients with either acute spontaneous bacterial peritonitis (SBP) or patients complicated with SBP. METHODS: A total of 112 patients was randomly allocated to two groups: 56 patients were allocated to be treated with ceftriaxone and 56 patients were allocated to treatment with ceftriaxone plus intra-venous albumin in 3 weeks. Serum creatinine and blood urea nitrogen levels were monitored. RESULTS: Of the 56 patients (group 2) treated with ceftriaxone and albumin, five patients had renal impairment. Of the 56 patients (group 1) treated with ceftriaxone alone, 19 had renal impairment. The incidence of renal impairment was significantly lower in patients treated with ceftriaxone and albumin (5/56; 10%) than in patients treated with ceftriaxone alone (19/56; 34%; P = 0.002). In addition, in-hospital mortality in group 2 was 10% (5/56), but was 33% (17/56) in group 1. Thus, in-hospital mortality was significantly reduced from 33% (17/56) in patients treated with ceftriaxone to 10% (5/56) in patients treated with ceftriaxone and albumin (P = 0.01). CONCLUSIONS: The addition of intravenous albumin to an antibiotic regimen reduces the incidence of renal impairment and mortality in cirrhotic patients with SBP.