Albumin Assisted Diuresis in Patients with Cirrhosis and Ascites

Inclusion Criteria:

* Outpatient patients with decompensated cirrhosis with past or current ascites and persistent lower extremity edema despite oral diuretic titration
* Serum albumin of \< 3.5 g/dL
* Age \>=18 years old

Exclusion Criteria:

* Patients with GFR \< 30mL/min/1.73 m2
* Changes in oral diuretic regimen in the past 7 days (\*\*patients can enter the study after 7 days of the change)
* Large Volume paracentesis (LVP) in the past 7 days (\*\*patients can enter the study after 7 days)
* Albumin infusion within the previous 14 days (\*\* patients can enter the study after 14 days)
* Spontaneous Bacterial Peritonitis in the past month
* Active variceal bleeding
* Current Hepatic encephalopathy (\>= Grade 2 based on West Haven criteria)
* Co-administration of other diuretics such as Hydrochlorothiazide (amiloride or eplerenone in place of spironolactone, and Bumex/Torsemide in place of furosemide are acceptable)
* Hypotension (Mean Arterial Pressure \<65 mmHg, Systolic Blood pressure \<90 mmHg)
* Severe hyponatremia (Sodium \<125 mEq/L)
* previous diagnosis of overt heart failure (systolic EF \< 50%)
* Baseline oxygen requirement
* Hypersensitivity to albumin preparations