Early albumin level and mortality in hemodialysis patients: a retrospective study.

ABSTRACT

BACKGROUND: Hypoalbuminemia is a significant risk factor of cardiovascular disease and all-cause death in patients undergoing conventional hemodialysis (HD). However, the albumin (ALB) level of these dialysis patients runs through the whole process of dialysis, and the prognostic value of serum ALB in the early stage of HD and the relationship between the early ALB value and death in HD patients has not been reported. METHODS: The data of 447 patients with HD were retrospectively analyzed. The patients were stratified into three ALB (g/L) groups low, ALB ≤34.2; moderate, 34.3< ALB <40.1; high, ALB ≥40.2. Survival trends of the three groups were analyzed by the Kaplan-Meier method. RESULTS: Comparison of the clinical data among the three groups showed a positive correlation between Hb, RBC, K+, Ca2+, Mg2+, and PHOS (P<0.05), but a negative correlation between age and high-sensitivity C-reactive protein (hsCRP) (P<0.05). The ALB level in early HD patients was an independent predictor of death [hazard ratio (HR) =0.945; 95% confidence interval (CI) 0.916-0.976; P=0.000], while age and hsCRP were protective factors (HR =1.048, 95% CI 1.028-1.067, P=0.000; HR =1.049, 95% CI 1.024-1.075, P=0.000). The estimated median overall survival (OS) at early HD was 56.00 months in the low ALB group, 83.00 months in the moderate ABL group, and 95.00 months in the high ALB group. The Kaplan-Meier estimate of survival showed a significant difference in OS among the three groups (log-rank P=0.000). CONCLUSIONS: The early ALB level not only reflects the nutritional and chronic inflammation status of HD patients, but can also predict the prognosis, which has guiding significance for the management of HD patients.