# Low‐Dose vs. Standard Care Iv Human Albumin During Large‐Volume Paracentesis in Patients With Liver Cirrhosis: A Systematic Review

## TL;DR

This review suggests lower doses of human albumin during a procedure for liver disease patients may be as safe and effective as standard doses, but more high-quality studies are needed.

## Contribution

The study compares low-dose versus standard-dose human albumin during large-volume paracentesis in cirrhosis patients, suggesting potential for dose reduction.

## Key findings

- Low-dose human albumin (2–6.5 g/L) showed similar safety and efficacy compared to standard dosing in preventing complications.
- No significant differences were observed in outcomes like renal dysfunction or paracentesis-induced circulatory dysfunction.
- Current evidence is limited by small sample sizes and study design issues, requiring larger trials for confirmation.

## Abstract

Cirrhosis is a global health concern, with ascites being the most prevalent decompensating event. Intravenous (IV) human albumin (HA) is administered during large‐volume paracentesis (LVP) to prevent complications. The standard (6–8 g HA/L ascites) is empirically chosen, potentially leading to overtreatment and added costs. We reviewed evidence comparing the efficacy and safety of reduced versus standard‐care HA dosing during LVP. We searched PubMed, EMBASE, Cochrane Library, CINAHL, and Scopus (up to January 31, 2025). We included RCTs and cohort studies in adults with cirrhosis undergoing LVP, comparing low‐dose (≤ 6 g/L or ≤ 20 g total) to standard‐dose (> 6 g/L or > 20 g total) HA. Outcomes included paracentesis‐induced circulatory dysfunction (PICD), renal impairment, hyponatremia, other decompensating events, and survival. Quality assessment used Cochrane risk‐of‐bias tools and Newcastle–Ottawa Scale. Five studies (three full‐text, two abstracts) met inclusion criteria. Low‐dose regimens (2–6.5 g/L) showed no significant difference compared to standard care (6–8.3 g/L) in PICD (reported in two studies) and renal dysfunction (reported in five studies). Other secondary outcomes, including hyponatremia, GI bleeding, HE, infections, and reaccumulating ascites, also showed no statistical differences. While these findings indicate potential for dose reduction, definitive confirmation via meta‐analysis was not feasible due to methodological heterogeneity. Available evidence suggests that reduced‐dose IV HA (≤ 6 g/L) is as effective and safe as standard‐dose HA (6–8 g/L) during LVP. However, the quality of the current evidence is limited by small sample sizes and suboptimal study designs, and well‐designed, adequately powered future studies are required to confirm these findings.

People with advanced liver disease can develop fluid build‐up in the abdomen (ascites), which is treated by draining the fluid and giving human albumin to prevent complications. The amount of albumin currently used is based on limited evidence, even though albumin is costly, scarce, and may cause side effects if overused. This review suggests that lower doses of albumin may be just as safe and effective as standard doses, but larger, high‐quality studies are needed to confirm this.

A reduced dose of IV human albumin (2–6.5 g/L) during LVP appears to have similar safety and efficacy compared with standard dosing, though the level of evidence is low.Current studies are restricted by methodological limitations, heterogeneous dosing regimens, and reliance on surrogate endpoints like PICD.A well‐designed, adequately powered non‐inferiority trial is needed to confirm these findings.

A reduced dose of IV human albumin (2–6.5 g/L) during LVP appears to have similar safety and efficacy compared with standard dosing, though the level of evidence is low.

Current studies are restricted by methodological limitations, heterogeneous dosing regimens, and reliance on surrogate endpoints like PICD.

A well‐designed, adequately powered non‐inferiority trial is needed to confirm these findings.