Low albumin levels tied to increased risk for ESRD

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Takeaway

  • Lower serum albumin (SA) is linked to an increased risk for end-stage renal disease (ESRD), independent of baseline estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (ACR), and other risk factors.

Why this matters

  • This is the first community-level study to link SA to ESRD while accounting for ACR.
  • Stronger association with baseline eGFR (in mL/minute/1.73 m2) ≥60.

Study design

  • REGARDS study: 19,633 participants aged ≥45 years (mean age, 63.9±9.7 years; female, 62%; black, 40%).
  • Analyses adjusted for demographics, comorbidities, eGFR, ACR, and other clinical/laboratory risk factors.
  • Funding: National Institute of Neurological Disorders and Stroke, NIH.

Key results

  • Mean baseline eGFR (creatinine-cystatin C equation), 83.3±20.8.
  • ESRD incidence: 1.2% over a median of 8 years.
  • ESRD risk was 61% and 69% higher in the first and second vs fourth SA quartile (
  • Baseline eGFR ≥60: ESRD risk was 7.36-fold and 3.96-fold higher in the first and second vs fourth SA quartile (HR=7.36 [95% CI, 2.20-24.63], 3.96 [95% CI, 1.12-14.09]).
  • Each standard deviation (0.33 g/dL) drop in SA was tied to a 16% increased risk for ESRD (HR=1.16; 95% CI, 1.01-1.33).
    • Risk was higher with eGFR ≥60 (HR=1.61; 95% CI, 1.21-2.15).

Limitations

  • Only black/white patients.