Serum Albumin Levels Associated with Mortality in Hemodialysis Patients

Serum albumin is commonly used as a proxy for nutritional status, as well as a marker of inflammation and a low serum albumin concentration is not only indicative of protein energy wasting in dialysis patients, but it is also a powerful predictor of the mortality risk in this population.

Several clinical conditions are associated with low serum albumin levels in dialysis patients, including infectious and inflammatory diseases, fluid overload, inadequate dialysis, severe co-morbidity, and taste change. Therefore, regular monitoring of serum albumin levels is useful for predicting outcomes in dialysis patients.

Scientists the Chang Gung University College of Medicine (Taoyuan City, Taiwan) and their colleagues included in a study 781 patients who received maintenance hemodialysis (HD) in a large, hospital-facilitated HD center. Five-year medical records (2009–2013) were retrospectively reviewed, and the cut-off level for serum albumin level was set at 3.5 g/dL. Serial haemogram results and biochemical data from the study period were collected and were analyzed retrospectively.

Corrected serum calcium was calculated and all blood samples were analyzed using commercial kits and the Hitachi 7600–210 autoanalyzer (Hitachi Ltd., Tokyo, Japan). Albumin was measured using the bromocresol green method; the normal range was 3.5–5.2 g/dL. The outcome measures included the associations between serum albumin reach rates (defined as the percentage of monthly serum albumin level recordings that were greater or equal to 3.5 g/dL) and time-averaged albumin levels in the first 2-year period with all-cause and cardiovascular mortality in the subsequent 3-year period.

The investigator found that among the 781 patients, 689 patients had higher albumin reach rates and 92 patients had lower albumin reach rates over the 5-year period. Older age and higher prevalence of diabetes were identified in the patients with lower albumin reach rates. Patients with higher albumin reach rates exhibited higher survival rates than those with lower albumin reach rates. In terms of haemogram and biophysical parameters, patients with lower albumin reach rates exhibited significantly lower values for albumin, blood urea nitrogen (BUN), creatinine (Cr), potassium (K), and phosphate (P), and higher levels of corrected serum calcium (Ca), ferritin, and cardiothoracic (CT) ratio than those with higher albumin reach rates.

The authors concluded that their study showed that a higher serum albumin level has a survival benefit in long-term HD patients. An obviously low albumin level should emphasize the need for initiating a management strategy and receiving appropriate medical intervention. The study was published on August 20, 2016, in the journal BMC Nephrology.

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Chang Gung University College of Medicine
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