Lower serum albumin before ESRD tied to poorer outcomes
Lower serum albumin levels before end-stage renal disease (ESRD) increases the risk of all-cause, cardiovascular and infection-related death after ESRD, a recent study has shown.
Researchers retrospectively assessed 29,124 adults (mean age, 67±11 years; 2 percent female) with advanced chronic kidney disease progressing to ESRD. Pre-ESRD serum albumin measurements were obtained from patient records, and its association with post-ESRD outcomes was determined.
Pre-ESRD, those with higher baseline serum albumin levels showed further increases, while those with lower starting concentrations displayed further declines; those with the lowest levels (<2.8 g/dL) had the steepest declines.
In the first 12 months after the transition to ESRD, 6,236 deaths were reported, resulting in a crude mortality rate of 25.6 deaths per 100 person-years. On top of this, 468 patients (2 percent) received transplants and 2,027 (7 percent) were lost to follow-up.
Participants who had serum albumin concentrations <2.8 g/dL were twice as likely to die as those with levels ≥4.0 g/dL (hazard ratio [HR], 2.07, 95 percent CI, 1.87–2.28). Hypoalbuminaemia (<3.5 g/dL) had the same effect across all subgroups of clinical characteristics and laboratory measurements.
Having low baseline albumin (<2.8 g/dL) also significantly increased the risk of cardiovascular (HR, 2.10, 1.77–2.49) and infection-related (HR, 2.62, 1.85–3.72) mortality relative to those in the highest category of serum albumin. The same was true for hospitalization, which occurred significantly more frequently in those with lower baseline albumin (incidence rate ratio, 1.50, 1.45–1.56).