Comparison of Albumin versus Fresh Frozen Plasma in the Treatment of Children with Diuretic-Resistant Oedema in Idiopathic Nephrotic Syndrome at a Tertiary Hospital

Open Access

Abstract

Introduction: Diuretic-resistant oedema is a common problem in children with idiopathic nephrotic syndrome (NS), largely driven by hypoalbuminaemia. Co-administration of human albumin with frusemide improves diuretic response, but albumin is costly and often unavailable in resource-limited settings; fresh frozen plasma (FFP) has been proposed as a cheaper alternative. Aim of the Study: To compare the efficacy and cost of human albumin versus fresh frozen plasma (FFP), each co-administered with frusemide, in the treatment of diuretic-resistant oedema in children with idiopathic NS. Methods & Materials: This randomized clinical trial was conducted in the Department of Pediatrics and Pediatric Nephrology Ward, Chittagong Medical College Hospital (CMCH), Chattogram, Bangladesh, from July 2020 to June 2021. A total of 100 children aged 1-12 years with idiopathic NS, diuretic-resistant oedema, and serum albumin <1.5 g/dL were randomly allocated by block randomization into an albumin group (n=50; intravenous 20% albumin 1 g/kg/day followed by intravenous frusemide) and an FFP group (n=50; intravenous FFP 15 mL/kg/day followed by intravenous frusemide). Clinical and laboratory parameters were monitored daily until dry weight was achieved. Data were analyzed using SPSS version 23.0, with p<0.05 considered statistically significant. Results: Baseline demographic, clinical, and biochemical parameters were comparable between groups (mean age 5.7±2.9 vs 6.3±2.9 years, p=0.121; male-female ratio 2.6:1 vs 1.4:1, p=0.105). Abdominal girth declined by 10.7±2.1% in the albumin group versus 9.8±2.4% in the FFP group (p=0.058), and body weight declined by 11.7±3.9% versus 10.7±4.2% (p=0.229), neither difference reaching statistical significance. Dry weight was achieved significantly earlier with albumin (median 13 days, IQR 12-14) than with FFP (median 14 days, IQR 13-15; p<0.001). The FFP group required a significantly larger infusion volume (median 330 mL vs 100 mL) and more infusions (2 vs 1; p<0.001), but its median treatment cost was significantly lower (750 BDT, IQR 500-1000) than albumin (6400 BDT, IQR 6400-12,800; p<0.001). No treatment-related complications were observed in either group. Conclusion: Albumin achieves dry weight faster than FFP, but the two regimens show comparable overall efficacy in reducing oedema. Given its substantially lower cost, FFP may serve as a feasible, cost-effective alternative to albumin for managing diuretic-resistant oedema in children with idiopathic NS in resource-limited settings.