title: Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis.
abstract: BACKGROUND
  Serum albumin level predicts mortality in dialysis patients and is used to assess their health status and the quality of delivered care. Whether the threshold level of serum albumin at which mortality risk increases in peritoneal dialysis (PD) patients is the same as for hemodialysis (HD) patients has not been studied.
  
  
  METHODS
  Observational cohort study of dialysis patients undertaken to determine the survival-predictability of serum albumin level in PD patients and compare it with that in HD patients.
  
  
  METHODS
  130,052 dialysis patients (PD, 12,171; HD, 117,851) who received treatment in any of the 580 dialysis units owned by DaVita Inc between July 1, 2001, through June 30, 2006, followed up through June 30, 2007.
  
  
  METHODS
  Baseline and time-averaged serum albumin level (assayed using bromcresol green) and change in serum albumin level over 6 months.
  
  
  METHODS
  All-cause, cardiovascular, and infection-related mortality.
  
  
  RESULTS
  PD patients with baseline serum albumin level <3.0 g/dL had a more than 3-fold higher adjusted risk of all-cause and cardiovascular mortality and 3.4-fold higher risk of infection-related mortality (reference group: serum albumin, 4.00-4.19 g/dL). Adjusted all-cause mortality was significantly lower in PD patients with a ≥0.3-g/dL increase in serum albumin level over 6 months and significantly higher in those for whom it decreased by ≥0.2 g/dL (reference group: serum albumin change, +0.1 to -0.1 g/dL). A significant increase in death risk was evident for HD patients with serum albumin level <4.0 g/dL, but at <3.8 g/dL for PD patients. For each albumin category, overall death risk for PD patients was lower than for HD patients (reference group: HD patients with serum albumin of 4.00-4.19 g/dL).
  
  
  CONCLUSIONS
  Study can identify associations only without attribution of causality and residual confounding cannot be excluded.
  
  
  CONCLUSIONS
  Serum albumin predicts all-cause, cardiovascular, and infection-related mortality in both PD and HD patients. However, the threshold at which risk of death increases varies by dialysis modality, and this difference should be considered by agencies or organizations that set quality standards.
authors: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA. rmehrotra@labiomed.org
authors: Rajnish
authors: R
authors: Mehrotra
authors: Uyen
authors: U
authors: Duong
authors: Sirin
authors: S
authors: Jiwakanon
authors: Csaba P
authors: CP
authors: Kovesdy
authors: John
authors: J
authors: Moran
authors: Joel D
authors: JD
authors: Kopple
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
references: Am J Transplant. 2011 May;11(5):1006-15
references: 21449945
references: J Am Soc Nephrol. 2010 Mar;21(3):499-506
references: 20133483
references: Am J Kidney Dis. 1999 Mar;33(3):523-34
references: 10070917
references: Ann Intern Med. 2006 Oct 3;145(7):512-9
references: 17015869
references: Perit Dial Int. 2005 Sep-Oct;25(5):445-52
references: 16178477
references: J Ren Nutr. 2009 Mar;19(2):127-35
references: 19218039
references: Perit Dial Int. 2007 Mar-Apr;27(2):192-5
references: 17299157
references: Kidney Int. 2001 Jul;60(1):333-40
references: 11422769
references: Nephrol Dial Transplant. 1997 Mar;12(3):554-8
references: 9075140
references: Nephrol Dial Transplant. 2005 Oct;20(10):2194-201
references: 16030031
references: Arch Intern Med. 2011 Jan 24;171(2):110-8
references: 20876398
references: Clin J Am Soc Nephrol. 2009 Jul;4(7):1201-6
references: 19478100
references: Kidney Int. 1981 Apr;19(4):593-602
references: 7241892
references: J Am Soc Nephrol. 1996 May;7(5):728-36
references: 8738808
references: Clin J Am Soc Nephrol. 2010 Aug;5(8):1463-70
references: 20538836
references: Nat Rev Nephrol. 2011 May 31;7(7):369-84
references: 21629229
references: J Am Soc Nephrol. 2002 May;13(5):1307-1320
references: 11961019
references: J Med Assoc Thai. 2006 Aug;89 Suppl 2:S138-45
references: 17044465
references: Am J Kidney Dis. 1997 Dec;30(6):923-7
references: 9398142
references: Kidney Int. 2003 Aug;64(2):649-56
references: 12846762
references: Kidney Int Suppl. 2006 Nov;(103):S55-62
references: 17080112
references: Kidney Int. 2009 Jul;76(1):97-107
references: 19340090
references: Kidney Int. 2008 Feb;73(4):480-8
references: 18046315
references: Am J Kidney Dis. 2009 Feb;53(2):290-7
references: 18805609
references: Am J Kidney Dis. 2003 Mar;41(3):664-9
references: 12612991
references: Nephrol Dial Transplant. 2005 Sep;20(9):1880-8
references: 15956056
references: Adv Ren Replace Ther. 2003 Jul;10(3):194-212
references: 14708073
references: Annu Rev Nutr. 2001;21:343-79
references: 11375441
references: Perit Dial Int. 2005 May-Jun;25(3):274-84
references: 15981776
references: Semin Nephrol. 2011 Mar;31(2):152-8
references: 21439429