title: Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease.
abstract: BACKGROUND
  Although serum albumin is a marker for malnutrition and associated with a higher mortality in adult patients with end-stage renal disease (ESRD), the risk of death associated with serum albumin is unknown in pediatric patients with ESRD. We evaluated the association between serum albumin and death among pediatric patients initiating dialysis.
  
  
  METHODS
  Data from the United States Renal Data System (USRDS) were used to identify all patients under the age of 18 who initiated dialysis between January 1, 1995 and December 31, 1998. Using the Cox proportional hazards models, the association between serum albumin obtained 45 days prior to dialysis initiation and death was estimated, controlling for demographic factors, dialysis modality, and anthropometric measures.
  
  
  RESULTS
  Of 1723 patients included in the analysis, there were 93 deaths over 2953 patient-years of observation. The multivariate analysis demonstrated that each -1 g/dL difference in serum albumin between patients was associated with a 54% higher risk of death [adjusted relative risk (aRR), 1.54; 95% confidence interval (CI), 1.15 to 1.85; P=0.002]. This was independent of glomerular causes for their ESRD and other potential confounding variables.
  
  
  CONCLUSIONS
  Pediatric patients initiating dialysis with hypoalbuminemia are at a higher risk for death. This finding persists after adjusting for glomerular causes for ESRD and other potential confounding variables. Low serum albumin at dialysis initiation is an important marker of mortality risk in pediatric ESRD patients.
authors.affiliation: Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-5311, USA. cwong@salud.unm.edu
authors.forename: Craig S
authors.initials: CS
authors.lastname: Wong
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Hingorani
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Gillen
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Sherrard
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Watkins
authors.forename: John R
authors.initials: JR
authors.lastname: Brandt
authors.forename: Adrianne
authors.initials: A
authors.lastname: Ball
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Stehman-Breen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D009748:Nutrition Disorders / Q000097:blood; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D012709:Serum Albumin