title: Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients: A 15-year Follow-Up Study.
abstract: Although initial serum albumin level is highly associated with overall and cardiovascular mortality in peritoneal dialysis (PD) patients, we consider that the dynamic change and trend of albumin after initiation of PD are also essential.We enrolled patients who received PD for more than 3 months from January 1999 to March 2014. We categorized these patients into 2 groups by the difference in serum albumin level (Δalbumin = difference between peak with initial albumin level = peak albumin level - initial albumin level) after PD. The patients with Δalbumin < 0.2 g/dL (median level) were considered as group A (n, number = 238) and those with Δalbumin ≥ 0.2 g/dL were considered as group B (n = 278). Further, we stratified these patients into quartiles: Q1 Δalbumin < -0.2 g/dL; Q2, -0.2 ≦∼ <0.2 g/dL; Q3, 0.2 ≦∼ <0.6 g/dL; and Q4, ≥0.6 g/dL. Regression analysis was performed to determine the correlation of initial albumin and Δalbumin.Group A patients presented with higher levels of serum albumin (3.71 ± 0.54 vs 3.04 ± 0.55 g/dL; P < 0.001) and hematocrit as well as better initial residual renal function. However, those in group A had lower serum albumin increment and downward-sloped trends after dialysis. In contrast, the albumin trend was upward sloped and the increment of albumin was remarkable in group B, despite the high prevalence of cardiovascular diseases and diabetes. Overtime, group A patients had poorer survival and experienced more frequent and longer hospitalizations. Group Q1 patients with least albumin increment had worst survival. Group Q4 patients with lowest initial albumin also had poor survival. Age, diabetes, cardiovascular diseases, BMI, initial albumin, and Δalbumin could affect patient outcomes independently. Regression analysis showed a better outcome can be obtained if the initial albumin level is at least above 3.15 g/dL. (Initial albumin level = -0.61 × Δalbumin + 3.50.)The increment and trend of albumin especially during early period of PD may be a more crucial determinant for survival.
authors.affiliation: From the Institute of Medicine (P-FC, H-RC); School of Medicine (P-FC, C-CC, H-RC), Chung Shan Medical University, Taichung; Division of Nephrology, Department of Internal Medicine (P-FC, C-CT, C-LW, H-HL, C-CC), Changhua Christian Hospital, Changhua; Molecular and Genomic Epidemiology Center (T-YY), China Medical University Hospital, Taichung; Division of Nephrology (H-HL), Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City (H-LC); Department of Nutrition and Dietetics; Internal Medicine Research Center (C-TK), Changhua Christian Hospital, Changhua; PhD. Program for Aging (C-CC), College of Medicine, China Medical University; and Division of Nephrology (H-RC), Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Ping-Fang
authors.initials: PF
authors.lastname: Chiu
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Tsai
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Wu
authors.forename: Tse-Yen
authors.initials: TY
authors.lastname: Yang
authors.forename: Hung-Hsiang
authors.initials: HH
authors.lastname: Liou
authors.forename: Hung-Lin
authors.initials: HL
authors.lastname: Chen
authors.forename: Chew-Teng
authors.initials: CT
authors.lastname: Kor
authors.forename: Chia-Chu
authors.initials: CC
authors.lastname: Chang
authors.forename: Horng-Rong
authors.initials: HR
authors.lastname: Chang
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011237:Predictive Value of Tests; D012709:Serum Albumin / Q000032:analysis*; D015996:Survival Rate; D013997:Time Factors
chemical_list: D012709:Serum Albumin