Impact of albumin variability during the first year on prognosis in peritoneal dialysis patients

This multicenter retrospective study aimed to evaluate the association between the coefficient of variation (CV) of serum albumin during the first year of peritoneal dialysis (PD) and clinical outcomes, including technique failure and all-cause mortality. We enrolled patients who initiated PD between January 1, 2018 and December 31, 2024 from three medical centers and maintained treatment for over one year. The albumin-CV was calculated from serial serum albumin measurements during the first year. Participants were categorized into low-, medium-, and high-variability groups based on albumin-CV tertiles. Primary endpoints were technique failure and all-cause mortality. Survival analyses were performed using Kaplan-Meier curves with log-rank tests. Multivariable Cox regression models were employed to assess independent associations. Among 759 included patients (mean age 57.81 ± 13.28 years; 58.8% male), 15.9% had diabetic nephropathy. After a median follow-up of 37 months, 66 technique failures and 170 all-cause deaths occurred. The high-albumin-variability group showed higher prevalence of diabetes and lower hemoglobin, albumin, calcium, and phosphorus levels (all p < 0.05). Albumin variability was significantly associated with all-cause mortality (log-rank χ² = 8.017, p = 0.013) but not with technique failure. After adjusting for confounders, albumin-CV remained an independent predictor of all-cause mortality (HR = 1.039, 95% CI 1.014-1.064, p = 0.002). Higher variability in serum albumin during the first year of PD is independently associated with increased risk of all-cause mortality.