title: Serum albumin levels predict clinical outcomes in chronic kidney disease (CKD) patients undergoing cardiac resynchronization therapy.
abstract: OBJECTIVE
  A low level of serum albumin is common in chronic kidney disease (CKD) patients with heart failure (HF). Cardiac resynchronization therapy (CRT), a novel therapeutic option, improves cardiac performance in patients with severe HF. In addition, CKD has recently been found to be associated with outcomes after CRT; however, the associations of the serum albumin levels with adverse events and the long-term prognosis in CKD patients who have undergone CRT are unknown. In this study, we investigated whether the albumin levels can be used to the predict mortality rate and incidence of cardiovascular events in CKD patients treated with CRT.
  
  
  METHODS
  A retrospective chart review was conducted in 102 consecutive CKD patients receiving a CRT device for the treatment of advanced HF. The long-term outcomes following device implantation were assessed according to the albumin levels.
  
  
  RESULTS
  During a median follow-up of 2.6 years, 34 patients (33.3%) died and 66 patients (64.7%) experienced cardiovascular events. A Kaplan-Meier survival analysis revealed that the CKD patients with decreased albumin levels exhibited significantly higher rates of all-cause mortality and cardiovascular events, including hospitalization for progressive HF, than the CKD patients without hypoalbuminemia. Importantly, a multivariate Cox regression analysis of confounding factors showed a low serum albumin level to independently predict all-cause death and cardiovascular events.
  
  
  CONCLUSIONS
  Hypoalbuminemia independently predicts cardiac morbidity and mortality in CKD patients receiving CRT. Assessing the albumin levels provides valuable information regarding the long-term prognosis in CKD patients who undergo CRT.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Uchikawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimano
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012709:Serum Albumin