Association of Pre-End-Stage Renal Disease Serum Albumin With Post-End-Stage Renal Disease Outcomes Among Patients Transitioning to Dialysis

Jui Ting Hsiung, Carola Ellen Kleine, Neda Naderi, Christina Park, Melissa Soohoo, Hamid Moradi, Connie M. Rhee, Yoshitsugu Obi, Joel D. Kopple, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Elani Streja

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Abstract

Objective: Serum albumin is a marker of malnutrition and inflammation and has been demonstrated as a strong predictor of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Yet, whether serum albumin levels in late-stage CKD are associated with adverse outcomes after the transition to ESRD is unknown. We hypothesize that lower levels and a decline in serum albumin in late-stage CKD are associated with higher risk of mortality and hospitalization rates 1 year after transition to ESRD. Design and Methods: This retrospective cohort study included 29,124 US veterans with advanced CKD transitioning to ESRD between 2007 and 2015. We evaluated the association of pre-ESRD (91 days before transition) serum albumin with 12-month post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates as well as the association of 1-year pre-ESRD albumin slope and 12-month post-ESRD mortality using hierarchical multivariable adjustments. Results: There was a negative linear association between serum albumin and all-cause mortality, such that risk doubled (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.87, 2.28) for patients with the lowest serum albumin <2.8 g/dL (ref: ≥4.0 g/dL) after full adjustment. A consistent relationship was observed between serum albumin and cardiovascular and infection-related mortality, and hospitalization outcomes. An increase in serum albumin of >0.25 g/dL/year was associated with reduced mortality risk (HR: 0.76, 95% CI: 0.63, 0.91) compared with a slight decline in albumin (ref: >−0.25 to 0 g/dL/year), whereas a decline more than 0.5 g/dL/year was associated with a 55% higher risk in mortality (HR: 1.55, 95% CI: 1.43, 1.68) in fully adjusted models. Conclusions: Lower pre-ESRD serum albumin was associated with higher post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates. Declining serum albumin levels in the pre-ESRD period were also associated with worse 12-month post-ESRD mortality.

Original languageEnglish (US)
Pages (from-to)310-321
Number of pages12
JournalJournal of Renal Nutrition
Volume29
Issue number4
DOIs
StatePublished - Jul 1 2019

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Serum Albumin
Chronic Kidney Failure
Dialysis
Mortality
Chronic Renal Insufficiency
Cardiovascular Infections
Hospitalization
Confidence Intervals
Albumins
Veterans
Malnutrition
Cohort Studies
Retrospective Studies
Odds Ratio
Inflammation

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Nephrology

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Association of Pre-End-Stage Renal Disease Serum Albumin With Post-End-Stage Renal Disease Outcomes Among Patients Transitioning to Dialysis. / Hsiung, Jui Ting; Kleine, Carola Ellen; Naderi, Neda; Park, Christina; Soohoo, Melissa; Moradi, Hamid; Rhee, Connie M.; Obi, Yoshitsugu; Kopple, Joel D.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Streja, Elani.

In: Journal of Renal Nutrition, Vol. 29, No. 4, 01.07.2019, p. 310-321.

Research output: Contribution to journalArticle

Hsiung, JT, Kleine, CE, Naderi, N, Park, C, Soohoo, M, Moradi, H, Rhee, CM, Obi, Y, Kopple, JD, Kovesdy, C, Kalantar-Zadeh, K & Streja, E 2019, 'Association of Pre-End-Stage Renal Disease Serum Albumin With Post-End-Stage Renal Disease Outcomes Among Patients Transitioning to Dialysis', Journal of Renal Nutrition, vol. 29, no. 4, pp. 310-321. https://doi.org/10.1053/j.jrn.2018.09.004
Hsiung, Jui Ting ; Kleine, Carola Ellen ; Naderi, Neda ; Park, Christina ; Soohoo, Melissa ; Moradi, Hamid ; Rhee, Connie M. ; Obi, Yoshitsugu ; Kopple, Joel D. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar ; Streja, Elani. / Association of Pre-End-Stage Renal Disease Serum Albumin With Post-End-Stage Renal Disease Outcomes Among Patients Transitioning to Dialysis. In: Journal of Renal Nutrition. 2019 ; Vol. 29, No. 4. pp. 310-321.
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AU - Hsiung, Jui Ting

AU - Kleine, Carola Ellen

AU - Naderi, Neda

AU - Park, Christina

AU - Soohoo, Melissa

AU - Moradi, Hamid

AU - Rhee, Connie M.

AU - Obi, Yoshitsugu

AU - Kopple, Joel D.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

AU - Streja, Elani

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objective: Serum albumin is a marker of malnutrition and inflammation and has been demonstrated as a strong predictor of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Yet, whether serum albumin levels in late-stage CKD are associated with adverse outcomes after the transition to ESRD is unknown. We hypothesize that lower levels and a decline in serum albumin in late-stage CKD are associated with higher risk of mortality and hospitalization rates 1 year after transition to ESRD. Design and Methods: This retrospective cohort study included 29,124 US veterans with advanced CKD transitioning to ESRD between 2007 and 2015. We evaluated the association of pre-ESRD (91 days before transition) serum albumin with 12-month post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates as well as the association of 1-year pre-ESRD albumin slope and 12-month post-ESRD mortality using hierarchical multivariable adjustments. Results: There was a negative linear association between serum albumin and all-cause mortality, such that risk doubled (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.87, 2.28) for patients with the lowest serum albumin <2.8 g/dL (ref: ≥4.0 g/dL) after full adjustment. A consistent relationship was observed between serum albumin and cardiovascular and infection-related mortality, and hospitalization outcomes. An increase in serum albumin of >0.25 g/dL/year was associated with reduced mortality risk (HR: 0.76, 95% CI: 0.63, 0.91) compared with a slight decline in albumin (ref: >−0.25 to 0 g/dL/year), whereas a decline more than 0.5 g/dL/year was associated with a 55% higher risk in mortality (HR: 1.55, 95% CI: 1.43, 1.68) in fully adjusted models. Conclusions: Lower pre-ESRD serum albumin was associated with higher post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates. Declining serum albumin levels in the pre-ESRD period were also associated with worse 12-month post-ESRD mortality.

AB - Objective: Serum albumin is a marker of malnutrition and inflammation and has been demonstrated as a strong predictor of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Yet, whether serum albumin levels in late-stage CKD are associated with adverse outcomes after the transition to ESRD is unknown. We hypothesize that lower levels and a decline in serum albumin in late-stage CKD are associated with higher risk of mortality and hospitalization rates 1 year after transition to ESRD. Design and Methods: This retrospective cohort study included 29,124 US veterans with advanced CKD transitioning to ESRD between 2007 and 2015. We evaluated the association of pre-ESRD (91 days before transition) serum albumin with 12-month post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates as well as the association of 1-year pre-ESRD albumin slope and 12-month post-ESRD mortality using hierarchical multivariable adjustments. Results: There was a negative linear association between serum albumin and all-cause mortality, such that risk doubled (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.87, 2.28) for patients with the lowest serum albumin <2.8 g/dL (ref: ≥4.0 g/dL) after full adjustment. A consistent relationship was observed between serum albumin and cardiovascular and infection-related mortality, and hospitalization outcomes. An increase in serum albumin of >0.25 g/dL/year was associated with reduced mortality risk (HR: 0.76, 95% CI: 0.63, 0.91) compared with a slight decline in albumin (ref: >−0.25 to 0 g/dL/year), whereas a decline more than 0.5 g/dL/year was associated with a 55% higher risk in mortality (HR: 1.55, 95% CI: 1.43, 1.68) in fully adjusted models. Conclusions: Lower pre-ESRD serum albumin was associated with higher post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates. Declining serum albumin levels in the pre-ESRD period were also associated with worse 12-month post-ESRD mortality.

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