- 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.
- 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.
- 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).
- 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).
- Retrospective design.
- Potentially nongeneralizable.