Limits...
Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients

View Article: PubMed Central - PubMed

ABSTRACT

Although initial serum albumin level is highly associated with overall and cardiovascular mortality in peritoneal dialysis (PD) patients, we consider that the dynamic change and trend of albumin after initiation of PD are also essential.

We enrolled patients who received PD for more than 3 months from January 1999 to March 2014. We categorized these patients into 2 groups by the difference in serum albumin level (Δalbumin = difference between peak with initial albumin level = peak albumin level − initial albumin level) after PD. The patients with Δalbumin < 0.2 g/dL (median level) were considered as group A (n, number = 238) and those with Δalbumin ≥ 0.2 g/dL were considered as group B (n = 278). Further, we stratified these patients into quartiles: Q1 Δalbumin < −0.2 g/dL; Q2, −0.2 ≦∼ <0.2 g/dL; Q3, 0.2 ≦∼ <0.6 g/dL; and Q4, ≥0.6 g/dL. Regression analysis was performed to determine the correlation of initial albumin and Δalbumin.

Group A patients presented with higher levels of serum albumin (3.71 ± 0.54 vs 3.04 ± 0.55 g/dL; P < 0.001) and hematocrit as well as better initial residual renal function. However, those in group A had lower serum albumin increment and downward-sloped trends after dialysis. In contrast, the albumin trend was upward sloped and the increment of albumin was remarkable in group B, despite the high prevalence of cardiovascular diseases and diabetes. Overtime, group A patients had poorer survival and experienced more frequent and longer hospitalizations. Group Q1 patients with least albumin increment had worst survival. Group Q4 patients with lowest initial albumin also had poor survival. Age, diabetes, cardiovascular diseases, BMI, initial albumin, and Δalbumin could affect patient outcomes independently. Regression analysis showed a better outcome can be obtained if the initial albumin level is at least above 3.15 g/dL. (Initial albumin level = −0.61 × Δalbumin + 3.50.)

The increment and trend of albumin especially during early period of PD may be a more crucial determinant for survival.

No MeSH data available.


Participant flow diagram depicting the screening/enrollment process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998418&req=5

Figure 1: Participant flow diagram depicting the screening/enrollment process.

Mentions: Furthermore, in order to clarify the correlation of initial levels and increment of albumin, these patients were stratified into quartiles according to Δalbumin: quartile 1 (Q1) Δalbumin < −0.2 g/dL; quartile 2 (Q2), −0.2 ≦∼ <0.2 g/dL; quartile 3 (Q3), 0.2 ≦∼ <0.6 g/dL; and quartile 4 (Q4), ≥0.6 g/dL. The HRs were computed and compared with Q1 group. The distribution of primary renal diseases, comorbidities, education level, occupation, and baseline characteristics were also comparable between these 4 groups. Major events requiring hospitalization occurring after initiation of PD were also surveyed. Bromocresol purple dye method was adopted for laboratory albumin measurement. To improve the quality of reporting in observational studies, the manuscript was organized in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology statement.16 The patient flow chart is shown in Figure 1, which includes the number of patients recruited and excluded from the study. The approval of the Institutional Review Board of the Changhua Christian Hospital was obtained (IRB No.140516).


Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients
Participant flow diagram depicting the screening/enrollment process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998418&req=5

Figure 1: Participant flow diagram depicting the screening/enrollment process.
Mentions: Furthermore, in order to clarify the correlation of initial levels and increment of albumin, these patients were stratified into quartiles according to Δalbumin: quartile 1 (Q1) Δalbumin < −0.2 g/dL; quartile 2 (Q2), −0.2 ≦∼ <0.2 g/dL; quartile 3 (Q3), 0.2 ≦∼ <0.6 g/dL; and quartile 4 (Q4), ≥0.6 g/dL. The HRs were computed and compared with Q1 group. The distribution of primary renal diseases, comorbidities, education level, occupation, and baseline characteristics were also comparable between these 4 groups. Major events requiring hospitalization occurring after initiation of PD were also surveyed. Bromocresol purple dye method was adopted for laboratory albumin measurement. To improve the quality of reporting in observational studies, the manuscript was organized in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology statement.16 The patient flow chart is shown in Figure 1, which includes the number of patients recruited and excluded from the study. The approval of the Institutional Review Board of the Changhua Christian Hospital was obtained (IRB No.140516).

View Article: PubMed Central - PubMed

ABSTRACT

Although initial serum albumin level is highly associated with overall and cardiovascular mortality in peritoneal dialysis (PD) patients, we consider that the dynamic change and trend of albumin after initiation of PD are also essential.

We enrolled patients who received PD for more than 3 months from January 1999 to March 2014. We categorized these patients into 2 groups by the difference in serum albumin level (&Delta;albumin&#8202;=&#8202;difference between peak with initial albumin level&#8202;=&#8202;peak albumin level&#8202;&minus;&#8202;initial albumin level) after PD. The patients with &Delta;albumin &lt; 0.2&#8202;g/dL (median level) were considered as group A (n, number&#8202;=&#8202;238) and those with &Delta;albumin &ge; 0.2&#8202;g/dL were considered as group B (n&#8202;=&#8202;278). Further, we stratified these patients into quartiles: Q1 &Delta;albumin &lt; &minus;0.2&#8202;g/dL; Q2, &minus;0.2&#8202;&#8806;&sim;&#8202;&lt;0.2&#8202;g/dL; Q3, 0.2&#8202;&#8806;&sim;&#8202;&lt;0.6&#8202;g/dL; and Q4, &ge;0.6&#8202;g/dL. Regression analysis was performed to determine the correlation of initial albumin and &Delta;albumin.

Group A patients presented with higher levels of serum albumin (3.71&#8202;&plusmn;&#8202;0.54 vs 3.04&#8202;&plusmn;&#8202;0.55&#8202;g/dL; P&#8202;&lt;&#8202;0.001) and hematocrit as well as better initial residual renal function. However, those in group A had lower serum albumin increment and downward-sloped trends after dialysis. In contrast, the albumin trend was upward sloped and the increment of albumin was remarkable in group B, despite the high prevalence of cardiovascular diseases and diabetes. Overtime, group A patients had poorer survival and experienced more frequent and longer hospitalizations. Group Q1 patients with least albumin increment had worst survival. Group Q4 patients with lowest initial albumin also had poor survival. Age, diabetes, cardiovascular diseases, BMI, initial albumin, and &Delta;albumin could affect patient outcomes independently. Regression analysis showed a better outcome can be obtained if the initial albumin level is at least above 3.15&#8202;g/dL. (Initial albumin level&#8202;=&#8202;&minus;0.61&#8202;&times;&#8202;&Delta;albumin&#8202;+&#8202;3.50.)

The increment and trend of albumin especially during early period of PD may be a more crucial determinant for survival.

No MeSH data available.