title: Association Between Hemodiafiltration and Hypoalbuminemia in Middle-Age Hemodialysis Patients.
abstract: The advantage of hemodiafiltration (HDF) is well known. One of the disadvantages of HDF is loss of serum albumin, but this issue is still obscure. Some risk factors associated with mortality were age dependent. Studies on serum albumin/hypoalbuminemia and HDF in different age stratification were limited. The aim of this cross-sectional study was to assess the role of HDF and other clinical variables on serum albumin values in maintenance hemodialysis (MHD) patients of different age groups. We recruited a total of 1216 patients on MHD. Patients were divided into 4 groups by age stratification of youth (<30 years old), young-middle age (30-44 years old), middle age (45-64 years old), and old age (≥65  years old). Biochemical, hematological, nutritional, inflammatory parameters, and receiving HDF or not were recorded. The associations between age groups, HDF, and variables mentioned above were analyzed. Only in middle-age group, patients with HDF was significantly (P = 0.013) associated with serum albumin <4 g/dL. In middle-age group, a multivariate-forward logistic regression analysis showed that male sex (2.169 [1.029, 4.574], P = 0.042), inflammation (4.167 [2.043, 8.498], P < 0.001), cardiovascular disease (2.92 [1.019, 8.402], P = 0.046), serum creatinine level (0.639 [0.538, 0.758], P < 0.001), and cholesterol level (0.984 [0.975, 0.993], P = 0.001) were associated with serum albumin level <3.6 g/dL. Hepatitis C virus infection (1.911 [1.186, 3.077], P = 0.008), HDF (2.143 [1.298, 3.540], P = 0.003), inflammation (2.309 [1.549, 3.440], P < 0.001), use of arterio-venous fistula (0.518 [0.327, 0.820], P = 0.005), Kt/V (0.395 [0.193, 0.809], P = 0.011), nonanuria (0.542 [0.337, 0.870], P = 0.011), serum creatinine level (0.744 [0.669, 0.828], P < 0.001), and cholesterol level (0.993 [0.987, 0.998], P = 0.013) were associated with serum albumin level <4 g/dL. HDF can predict serum albumin level <4 g/dL in middle-age HD patients. The effect of age needs to be taken into consideration when interpreting the correlation between hypoalbuminemia and HDF.
authors.affiliation: From the Department of Nephrology and Division of Clinical Toxicology (C-HW, C-WH, T-HY, W-HH), Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine (C-HW, C-WH, C-CH, T-HY, W-HH), Taoyuan; and Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital (C-CH), Keelung, Taiwan.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Hu
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects*; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology*; D007249:Inflammation / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis
chemical_list: D008055:Lipids; D012709:Serum Albumin