- 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.
- 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.
- 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).
- Only black/white patients.