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Albumin-corrected anion gap and mortality risk in cardiorenal syndrome: Insights from a nationally representative

Hongman Li1,2, Xing Huang2,3, Shengyong Si1,2

  • 1Department of Hypertension, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.

Medicine
|June 27, 2026
PubMed

Insights

Higher albumin-corrected anion gap (ACAG) levels in cardiorenal syndrome (CRS) patients are linked to increased mortality risk. This finding highlights ACAG as a potential tool for risk stratification in nephrology.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Chemistry

Background:

  • The prognostic value of the albumin-corrected anion gap (ACAG) in cardiorenal syndrome (CRS) is not well-established.
  • CRS involves complex interactions between cardiac and renal systems, impacting patient outcomes.

Purpose of the Study:

  • To investigate the association between ACAG levels and mortality in a large, nationally representative cohort of CRS patients.
  • To determine if ACAG can serve as a prognostic marker for all-cause and cardiovascular mortality in CRS.

Main Methods:

  • Utilized data from the National Health and Nutrition Examination Survey (2005-2018) for 1783 CRS patients.
  • Employed Cox regression, Kaplan-Meier curves, and restricted cubic spline analyses to assess mortality risks.
  • Conducted subgroup analyses to evaluate consistency across different demographic and clinical characteristics.

Main Results:

  • Higher ACAG levels were independently associated with increased risks of both all-cause mortality (HR=1.14, 95% CI: 1.09-1.18) and cardiovascular mortality (HR=1.14, 95% CI: 1.08-1.21).
  • A significant linear dose-response relationship was observed between ACAG levels and mortality.
  • These associations remained consistent across various subgroups.

Conclusions:

  • Elevated ACAG is a significant predictor of higher all-cause and cardiovascular mortality in patients with CRS.
  • ACAG represents a simple, accessible, and cost-effective biomarker for risk stratification in nephrology practice.
  • This study is the first to demonstrate the prognostic utility of ACAG in the context of CRS.

Keywords:
ACAGNHANESall-cause mortalitycardiorenal syndromecardiovascular mortality

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