title: Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study.
abstract: BACKGROUND
  The relationship between protein-energy wasting and chronic kidney disease (CKD) progression is unknown. In the present prospective cohort study, we evaluated the hypothesis that a combination of low body mass index (BMI) and serum albumin level is associated with rapid CKD progression.
  
  
  METHODS
  The study cohort comprised 728 predialysis Japanese patients with CKD (stages 2-5) enrolled from 2010 to 2011. Patients were categorized into four groups according to their serum albumin levels and BMI: group 1, low serum albumin level (<4 g/dL) and low BMI (<23.5 kg/m2); group 2, high serum albumin level (≥4 g/dL) and low BMI; group 3, low serum albumin level and high BMI (≥23.5 kg/m2); and group 4, high serum albumin level and high BMI. The primary outcome was a 30 % decline in estimated glomerular filtration rate (eGFR) or start of dialysis within 2 years. The secondary outcome was an annual GFR decline (mL/min/1.73 m2/year).
  
  
  RESULTS
  Logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that only group 1 was associated with a significant risk of CKD progression, with adjusted odds ratio of 3.51 [95 % confidence interval (CI) (1.63, 7.56)]. A multivariate linear regression analysis adjusted for baseline characteristics showed a significant difference in annual eGFR decline between groups 1 and 4 [coefficients β (standard error) -2.62 (0.75), p = 0.001].
  
  
  CONCLUSIONS
  This study suggests that combined effects of low BMI (<23.5 kg/m2) and serum albumin level (<4 g/dL) are associated with CKD progression.
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Department of Nephrology, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo, 153-8934, Japan. tokyo.kyosai.kanda@gmail.com.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Mandai
authors.affiliation: Department of Nephrology, JA Toride Medical Center, Ibaraki, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Akazawa
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Iimori
authors.affiliation: Department of Nephrology, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo, 153-8934, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Oi
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Naito
authors.affiliation: Department of Nephrology, Nitobe Memorial Nakano General Hospital, Tokyo, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Noda
authors.affiliation: Department of Nephrology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Toda
authors.affiliation: Department of Nephrology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Eisei
authors.initials: E
authors.lastname: Sohara
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okado
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tatemitsu
authors.initials: T
authors.lastname: Rai
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016009:Chi-Square Distribution; D018450:Disease Progression; D015536:Down-Regulation; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D000075462:Serum Albumin, Human; D013851:Thinness / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D014041:Tokyo
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000075462:Serum Albumin, Human
keywords: Albumin; Body mass index; Chronic kidney disease; Nutrition; Protein–energy wasting