Association between Changes in Serum Albumin Levels and Survival of Hemodialysis Patients

Shih-Jiun Lin ； Yann-Hwa Wang ； Yung-Chien Hsu ； Chia-Hao Chang ； Chun-Liang Lin

《Acta Nephrologica》 35卷4期 (2021/12) Pp. 198-210

https://doi.org/10.6221/AN.202112_35(4).0005

摘要

BACKGROUND: Serum albumin, a marker commonly used to reflect nutritional status, is closely associated with mortality in hemodialysis patients. It is known that patients with high baseline levels of serum albumin usually have a longer lifespan than those with low albumin levels. However, whether changes in albumin levels (Δalbumin) influence mortality of hemodialysis patients is unknown. To investigate the long-term effects of Δalbumin on the survival of prevalent hemodialysis patients, we conducted this retrospective cohort study. METHODS: In this retrospective cohort study, 393 patients on maintenance hemodialysis were enrolled and followed up during the period from March 2014 to March 2020. ΔAlbumin was defined as ([serum albumin level at one year after enrollment - baseline serum albumin level]/baseline serum albumin level × 100%) and used as a predictor. Survival analysis was studied by the Kaplan-Meier method. Risk factor of all-cause mortality was conducted by univariate and multivariate cox proportional hazards models. RESULTS: The total mortality rate was 30.8% (121/393). The mean survival duration was 3.8 ± 1.7 years. The Kaplan-Meier analysis revealed that the group with high Δalbumin had a longer lifespan than the group with low Δalbumin. After adjustment with confounding factors by multivariate Cox proportional hazards regression analysis, this study confirmed that Δalbumin was associated with survival with a hazard ratio of 0.948 and 95% confidence interval of 0.925-0.970. These results indicated that Δalbumin is an independent risk factor for mortality in hemodialysis patients. Specifically, we found that, although decreased Δalbumin was significantly associated with mortality in those hemodialysis patients with relatively poor baseline nutritional status (baseline serum albumin ＜ 4 g/dL), the same association was unobserved among those with relatively better nutritional status. CONCLUSION: ΔAlbumin is an independent factor associated with hemodialysis patients' survival, especially in those with relatively poor baseline nutritional status (baseline serum albumin ＜ 4 g/dL). During daily dialysis practice, if initial serum albumin levels less than 4.0 g/dL were noticed, nutritional therapeutic intervention could improve patients' outcomes.

關鍵字

changes in serum albumin levels ； hemodialysis ； mortality ； retrospective cohort study ； nutritional status