Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia.


Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models.


Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%, p = 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%, p = 0.0057, OR: 1.50 95% CI: 1.13–2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR.


Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.

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  1. Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA

    • Jasmohan S. Bajaj MD
    •  & Leroy R. Thacker PhD
  2. University of Alberta, Edmonton, AB, Canada

    • Puneeta Tandon MD
  3. Dallas VA Medical Center and Baylor University Medical Center, Dallas, TX, USA

    • Jacqueline G. O’Leary MD
  4. University of Washington, Seattle, WA, USA

    • Scott W. Biggins MD
  5. University of Denver, Colorado, CO, USA

    • Scott W. Biggins MD
  6. University of Toronto, Toronto, ON, Canada

    • Florence Wong MD
  7. Mayo Clinic, Rochester, MN, USA

    • Patrick S. Kamath MD
  8. Yale University Medical Center, West Haven, CT, USA

    • Guadalupe Garcia-Tsao MD
  9. University of Tennessee, Memphis, TN, USA

    • Benedict Maliakkal MD
  10. University of Rochester, Rochester, NY, USA

    • Benedict Maliakkal MD
  11. University of California, San Francisco, CA, USA

    • Jennifer C. Lai MD
  12. University of Arizona, Phoenix, AZ, USA

    • Michael Fallon MD
  13. University of Texas, Houston, TX, USA

    • Michael Fallon MD
  14. Mercy Medical Center, Baltimore, MD, USA

    • Paul Thuluvath MD
  15. Mayo Clinic, Scottsdale, AZ, USA

    • Hugo E. Vargas MD
  16. Emory University Medical Center, Atlanta, GA, USA

    • Ram M. Subramanian MD
  17. University of Pennsylvania, Philadelphia, PA, USA

    • K. Rajender Reddy MD


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Guarantor of the article

JSB is the guarantor of the article.

Specific author contributions

All authors enrolled patients and were responsible for drafting and editing the manuscript. LRT was involved in the statistical analysis.

Financial Support

The NACSELD registry was supported by an investigator-initiated grant from Grifols Pharmaceuticals.

Potential competing interests

JSB, FW, GGT, SWB, JO, KRR, and PT are consultants for Grifols Pharmaceuticals. The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Jasmohan S. Bajaj MD.

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