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Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients

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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.


Pairwise comparison of risk in quartile groups. When compared with Q1 patients, the hazard ratio was reduced in groups Q2 and Q3 separately. For Q4 patients, the benefit from albumin gain was no longer obtained. (The pairwise comparison across each quartile of Δalbumin was performed by using Tukey's method and the corresponding adjusted P-value was calculated.).
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Figure 4: Pairwise comparison of risk in quartile groups. When compared with Q1 patients, the hazard ratio was reduced in groups Q2 and Q3 separately. For Q4 patients, the benefit from albumin gain was no longer obtained. (The pairwise comparison across each quartile of Δalbumin was performed by using Tukey's method and the corresponding adjusted P-value was calculated.).

Mentions: After further stratification of these patients into quartiles based on Δalbumin, the baseline characteristics were comparable between these 4 groups with exception of age and initial albumin level. Group Q1 patients were the oldest and Q4 patients were the youngest (Q1: 59.2 ± 14.6, Q2: 56.0 ± 16.1, Q3: 51.6 ± 14.5, and Q4: 49.1 ± 14.7 year-old; P < 0.001). The initial serum album levels of 4 groups are, respectively, described as follows: group Q1: 3.77 ± 0.59 g/dL, Q2: 3.63 ± 0.49 g/dL, Q3: 3.30 ± 0.52 g/dL, and Q4: 2.82 ± 0.49 g/dL, P < 0.001. The risk curve of plot for mortality was drawn as shown in Figure 3. When compared with Q1 patients, the HR was reduced in groups Q2 and Q3 (Figure 4). For Q4 patients, the benefit for survival from albumin gain was no longer maintained. The correlation of initial albumin and Δalbumin was computed and is demonstrated in Figure 5. The formula was: initial albumin level = −0.61 × Δalbumin + 3.50. For a uremic patient considering PD as renal replacement therapy to obtain the better survival benefit from albumin gain, the lowest initial albumin level is not less than 3.15 g/dL.


Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients
Pairwise comparison of risk in quartile groups. When compared with Q1 patients, the hazard ratio was reduced in groups Q2 and Q3 separately. For Q4 patients, the benefit from albumin gain was no longer obtained. (The pairwise comparison across each quartile of Δalbumin was performed by using Tukey's method and the corresponding adjusted P-value was calculated.).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Pairwise comparison of risk in quartile groups. When compared with Q1 patients, the hazard ratio was reduced in groups Q2 and Q3 separately. For Q4 patients, the benefit from albumin gain was no longer obtained. (The pairwise comparison across each quartile of Δalbumin was performed by using Tukey's method and the corresponding adjusted P-value was calculated.).
Mentions: After further stratification of these patients into quartiles based on Δalbumin, the baseline characteristics were comparable between these 4 groups with exception of age and initial albumin level. Group Q1 patients were the oldest and Q4 patients were the youngest (Q1: 59.2 ± 14.6, Q2: 56.0 ± 16.1, Q3: 51.6 ± 14.5, and Q4: 49.1 ± 14.7 year-old; P < 0.001). The initial serum album levels of 4 groups are, respectively, described as follows: group Q1: 3.77 ± 0.59 g/dL, Q2: 3.63 ± 0.49 g/dL, Q3: 3.30 ± 0.52 g/dL, and Q4: 2.82 ± 0.49 g/dL, P < 0.001. The risk curve of plot for mortality was drawn as shown in Figure 3. When compared with Q1 patients, the HR was reduced in groups Q2 and Q3 (Figure 4). For Q4 patients, the benefit for survival from albumin gain was no longer maintained. The correlation of initial albumin and Δalbumin was computed and is demonstrated in Figure 5. The formula was: initial albumin level = −0.61 × Δalbumin + 3.50. For a uremic patient considering PD as renal replacement therapy to obtain the better survival benefit from albumin gain, the lowest initial albumin level is not less than 3.15 g/dL.

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.