title: Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients.
abstract: OBJECTIVE
  We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients.
  
  
  METHODS
  Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause.
  
  
  RESULTS
  1,679 incident patients were included. They were 52 ± 15 years old, 58.7% male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923 patients had sAlb < 38 g/L (Low sAlb Group) and 756 ones had sAlb > 38.0 g/L (Adequate sAlb Group). The mortality was significantly higher in Low sAlb Group (17% vs. 11%, p < 0.001). Early changes in sAlb significantly affected two-year mortality. Factoring the Kaplan Meier curve of Low sAlb Group by the presence of an increase in sAlb uncovered of a statistically significant difference in mortality favoring the ones whose sAlb went up (19% vs. 15%, p = 0.043). Differently, patients from Adequate sAlb Group with a decrease in their sAlb had a statistically higher mortality rate (13% vs. 8%, p = 0.029).
  
  
  CONCLUSIONS
  Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb.
authors.affiliation: Universidade Federal Fluminense, Brazil.
authors.forename: Giselly Rosa Modesto
authors.initials: GR
authors.lastname: Pereira
authors.affiliation: Universidade Federal Fluminense, Brazil.
authors.forename: Jorge Paulo
authors.initials: JP
authors.lastname: Strogoff-de-Matos
authors.affiliation: Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Frederico
authors.initials: F
authors.lastname: Ruzany
authors.affiliation: Universidade do Estado do Rio de Janeiro, Brazil.
authors.forename: Sergio Fernando Ferreira
authors.initials: SF
authors.lastname: dos Santos
authors.affiliation: Fresenius Medical Care, Brasil.
authors.forename: Eufrônio
authors.initials: E
authors.lastname: D'Almeida Filho
authors.affiliation: Fresenius Medical Care, Brasil.
authors.forename: Marcos Sandro Fernandes
authors.initials: MS
authors.lastname: de Vasconcelos
authors.affiliation: Fresenius Medical Care, Brasil.
authors.forename: Ana Beatriz
authors.initials: AB
authors.lastname: Barra
authors.affiliation: Universidade Federal Fluminense, Brazil.
authors.forename: Jocemir Ronaldo
authors.initials: JR
authors.lastname: Lugon
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D013997:Time Factors
chemical_list: D012709:Serum Albumin