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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.


Related in: MedlinePlus

Trends of median values of albumin illustrated after initiation of peritoneal dialysis (PD). Dash line indicates the turning point of trajectory. At year 1, the peak level of serum albumin achieved after PD. Baseline value between group A and B were significantly different (3.8 vs 3.0 g/dL; P < 0.001a). However, the difference of value disappeared at 1 year (3.7 vs 3.8 g/dL; P = 0.09a). From 0 to 1 year, group B had an upward slope, but not for group A. Comparing to group A, the slope of group B was significantly greater (−0.1 vs +0.6 g/dL/year; P < 0.001b). The P for trends was 0.067 and <0.001c in group A and B, respectively. After 1 year, both groups had decreased trends with significant P for trends (0.012c vs 0.001c). Their slopes were not significantly distinct as well (−0.07 vs −0.09 g/dL/year; P = 0.37b). a, calculated by Mann–Whitney U-test; b, calculated by linear mixed model; and c, calculated by Jonckheere–Terpstra test.
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Figure 2: Trends of median values of albumin illustrated after initiation of peritoneal dialysis (PD). Dash line indicates the turning point of trajectory. At year 1, the peak level of serum albumin achieved after PD. Baseline value between group A and B were significantly different (3.8 vs 3.0 g/dL; P < 0.001a). However, the difference of value disappeared at 1 year (3.7 vs 3.8 g/dL; P = 0.09a). From 0 to 1 year, group B had an upward slope, but not for group A. Comparing to group A, the slope of group B was significantly greater (−0.1 vs +0.6 g/dL/year; P < 0.001b). The P for trends was 0.067 and <0.001c in group A and B, respectively. After 1 year, both groups had decreased trends with significant P for trends (0.012c vs 0.001c). Their slopes were not significantly distinct as well (−0.07 vs −0.09 g/dL/year; P = 0.37b). a, calculated by Mann–Whitney U-test; b, calculated by linear mixed model; and c, calculated by Jonckheere–Terpstra test.

Mentions: A total of 516 patients (278 females, 238 males) were included in the study. The baseline characteristics of all the patients are shown in Table 1. The initial albumin level of all the patients was 3.35 ± 0.64 g/dL, the peak albumin level was 3.7 ± 0.34 g/dL, and the end-PD albumin level was 2.92 ± 0.74 g/dL. The mean albumin levels at different time points, including initial, peak, and end of PD, were related to final survival (HR = 0.62, 0.34, and 0.57, respectively). Group A included 238 patients with Δalbumin < 0.2 g/dL, and group B included 278 patients with Δalbumin ≥ 0.2 g/dL. The time-lapsed median levels of albumin for groups A and B are separately shown in Figure 2. Baseline value between group A and B were significantly different. However, this statistic difference disappeared at year 1, the peak, and turning point of albumin trajectory. From 0 to 1 year, group B had an upward slope, but not for group A. The slope of group B was significantly greater than that of group A. The P for trend was also significant in group B. After 1 year, both groups had decreased trends with significant P for trends. But their slopes were not significantly distinct.


Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients
Trends of median values of albumin illustrated after initiation of peritoneal dialysis (PD). Dash line indicates the turning point of trajectory. At year 1, the peak level of serum albumin achieved after PD. Baseline value between group A and B were significantly different (3.8 vs 3.0 g/dL; P < 0.001a). However, the difference of value disappeared at 1 year (3.7 vs 3.8 g/dL; P = 0.09a). From 0 to 1 year, group B had an upward slope, but not for group A. Comparing to group A, the slope of group B was significantly greater (−0.1 vs +0.6 g/dL/year; P < 0.001b). The P for trends was 0.067 and <0.001c in group A and B, respectively. After 1 year, both groups had decreased trends with significant P for trends (0.012c vs 0.001c). Their slopes were not significantly distinct as well (−0.07 vs −0.09 g/dL/year; P = 0.37b). a, calculated by Mann–Whitney U-test; b, calculated by linear mixed model; and c, calculated by Jonckheere–Terpstra test.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Trends of median values of albumin illustrated after initiation of peritoneal dialysis (PD). Dash line indicates the turning point of trajectory. At year 1, the peak level of serum albumin achieved after PD. Baseline value between group A and B were significantly different (3.8 vs 3.0 g/dL; P < 0.001a). However, the difference of value disappeared at 1 year (3.7 vs 3.8 g/dL; P = 0.09a). From 0 to 1 year, group B had an upward slope, but not for group A. Comparing to group A, the slope of group B was significantly greater (−0.1 vs +0.6 g/dL/year; P < 0.001b). The P for trends was 0.067 and <0.001c in group A and B, respectively. After 1 year, both groups had decreased trends with significant P for trends (0.012c vs 0.001c). Their slopes were not significantly distinct as well (−0.07 vs −0.09 g/dL/year; P = 0.37b). a, calculated by Mann–Whitney U-test; b, calculated by linear mixed model; and c, calculated by Jonckheere–Terpstra test.
Mentions: A total of 516 patients (278 females, 238 males) were included in the study. The baseline characteristics of all the patients are shown in Table 1. The initial albumin level of all the patients was 3.35 ± 0.64 g/dL, the peak albumin level was 3.7 ± 0.34 g/dL, and the end-PD albumin level was 2.92 ± 0.74 g/dL. The mean albumin levels at different time points, including initial, peak, and end of PD, were related to final survival (HR = 0.62, 0.34, and 0.57, respectively). Group A included 238 patients with Δalbumin < 0.2 g/dL, and group B included 278 patients with Δalbumin ≥ 0.2 g/dL. The time-lapsed median levels of albumin for groups A and B are separately shown in Figure 2. Baseline value between group A and B were significantly different. However, this statistic difference disappeared at year 1, the peak, and turning point of albumin trajectory. From 0 to 1 year, group B had an upward slope, but not for group A. The slope of group B was significantly greater than that of group A. The P for trend was also significant in group B. After 1 year, both groups had decreased trends with significant P for trends. But their slopes were not significantly distinct.

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.


Related in: MedlinePlus