Serum albumin level and risk for mortality and hospitalization in adolescents on hemodialysis.
OBJECTIVE
National Kidney Foundation Dialysis Outcomes Quality Initiative practice guidelines recommend serum albumin > or = 4.0 g/dl for adults who are on hemodialysis. There is no established pediatric target for albumin and little evidence to support use of adult guidelines. This study examined the association between albumin and risk for death and hospitalization in adolescents who are on hemodialysis.


METHODS
This retrospective cohort study linked data on patients aged 12 to 18 yr in 1999 and 2000 from the Centers for Medicare and Medicaid Services' End Stage Renal Disease Clinical Performance Measures Project with 4-yr hospitalization and mortality records in the United States Renal Data System. Albumin was categorized as < 3.5/3.2, > or = 3.5/3.2 and < 4.0/3.7, and > or = 4.0/3.7 g/dl.


RESULTS
Of 675 adolescents, 557 were hospitalized and 50 died. Albumin > or = 4.0/3.7 g/dl was associated with male gender, Hispanic ethnicity, and higher hemoglobin level. Those with albumin > or = 4.0/3.7 g/dl had fewer deaths per 100 patient-years and fewer hospitalizations per time at risk. In multivariate analysis, patients with albumin > or = 4.0/3.7 g/dl had 57% decreased risk for death. Poisson regression showed progressive decrease in hospitalization risk as albumin level increased; however, confidence intervals were similar between albumin > or = 4.0/3.7 g/dl and albumin > or = 3.5/3.2 and < 4.0/3.7 g/dl.


CONCLUSIONS
This study demonstrates decreased mortality and hospitalization risk with albumin > or = 3.5/3.2 g/dl and suggests that adolescent hemodialysis patients who are able to achieve serum albumin > or = 4.0/3.7 g/dl may have the lowest mortality risk.
Amaral
Sandra
S
Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA. sandra_amaral@oz.ped.emory.edu
Hwang
Wenke
W
Fivush
Barbara
B
Neu
Alicia
A
Frankenfield
Diane
D
Furth
Susan
S
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016012:Poisson Distribution; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin