Low pre-ESRD albumin is tied to poorer survival on dialysis

  • Hsiung JT & al.
  • J Ren Nutr
  • 1 Jul 2019

  • International Clinical Digest
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Takeaway

  • Low serum albumin levels before progression to end-stage renal disease (ESRD) predict risk for early death within a year of transitioning to dialysis.

Why this matters

  • According to the authors, this study is the first to evaluate this association.
  • Further work is needed to determine the effect of managing pre-ESRD malnutrition and inflammation.

Study design

  • 29,124 US veterans (mean age, 67±11 years; 98% male) in the US Renal Data System, transitioning to ESRD; 74% had diabetes.
  • Pre-ESRD serum albumin measured 91 days pretransition (mean, 3.3±0.6 g/dL).
  • Funding: NIH.

Key results

  • During the first dialysis year, there were 6236 deaths (21.4%; 25.6 per 100 person-years); 2% underwent renal transplant, and 7% were lost to follow-up.
  • Using ≥4.0 g/dL as a reference, serum albumin
  • All-cause mortality: 2.07 (1.87-2.28);
  • Cardiovascular mortality: 2.10 (1.77-2.49); and
  • Infection-related mortality: 2.62 (1.85-3.72).
  • Steepest pre-ESRD annual decline in serum albumin (>0.5 g/dL) was associated with 55% higher 1-year mortality risk (HR, 1.55; 95% CI, 1.43-1.68) vs slight annual decline of 0 to −0.25 g/dL.
    • A >0.25 g/dL annual increase in serum albumin was tied to a 24% reduced mortality risk (HR, 0.76; 95% CI, 0.63-0.91).
  • Limitations

    • Retrospective design.
    • Potentially nongeneralizable.