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Serum albumin is a strong predictor of death in chronic dialysis patients
K Iseki1, N Kawazoe, K Fukiyama
1Third Department of Internal Medicine, School of Medicine, University of The Ryukyus, Okinawa, Japan.
Insights
This study identified key predictors of survival in hemodialysis patients. Lower serum albumin, serum creatinine, and higher age were significant factors influencing patient outcomes.
Area of Science:
- Nephrology
- Clinical Medicine
- Epidemiology
Background:
- Chronic hemodialysis is a life-sustaining treatment for end-stage renal disease.
- Patient survival on hemodialysis is influenced by a complex interplay of clinical factors.
- Identifying prognostic indicators is crucial for optimizing patient care and management.
Purpose of the Study:
- To evaluate the predictive value of various clinical and laboratory variables on survival rates in chronic hemodialysis patients.
- To identify key factors associated with mortality in this patient population.
- To understand the relationship between dialysis prescription and patient outcomes.
Main Methods:
- A cohort of 1,243 chronic hemodialysis patients in Okinawa, Japan, initiated in January 1991, was followed until April 1992.
- Basal clinical data including demographics, medical history, blood pressure, and blood chemistry were collected.
- Statistical analysis, including forward stepwise logistic regression, was employed to determine significant predictors of survival.
Main Results:
- Patients who died had significantly lower levels of total protein, serum albumin, total cholesterol, triglyceride, BUN, serum creatinine, body weight, body height, diastolic blood pressure, and duration of hemodialysis.
- Older age and diabetes mellitus were associated with poorer prognosis, though the predictive value of diabetes diminished when laboratory variables were considered.
- Key predictors of survival included age at entry, serum albumin, serum creatinine, body mass index (BMI), and male sex.
Conclusions:
- Serum albumin and serum creatinine levels are critical indicators of survival in chronic hemodialysis patients.
- Age and BMI are also significant factors influencing prognosis.
- Optimizing dialysis dose is correlated with improved serum creatinine, serum albumin, and BMI.
Abstract:
We examined the predictive value of various clinical variables in assessing survival in chronic hemodialysis patients (N = 1,243, 524 females, 719 males) who were under treatment with hemodialysis as of January 1991 in Okinawa, Japan and who were followed up until April 1992. Basal clinical data such as sex, starting date of dialysis, primary renal disease, blood pressure, blood chemistry values, and dialysis prescription data obtained just prior to dialysis were registered at the start of the study. As of the end of April 1992, 104 had died, 16 were transplant recipients, and five had been transferred. Those who died had significantly lower levels of total protein, serum albumin, total cholesterol, triglyceride, BUN, serum creatinine, body weight, body height, diastolic blood pressure, and duration of hemodialysis than those who survived. Older patients and those with diabetes mellitus had a poorer prognosis. A forward stepwise logistic procedure by SAS was used to determine the predictive value of the above clinical variables. With the addition of laboratory variables, the predictive value of diabetes was lost, as the diabetic patients had low serum levels of albumin and creatinine. The standardized coefficient was -0.380 (P = 0.0001) at age of entry, 0.316 (P = 0.0001) for serum albumin, 0.280 (P = 0.0001) for serum creatinine, 0.138 (P = 0.043) for body mass index (BMI), and -0.139 (P = 0.016) for male sex. The prescribed dialysis dose (M2 hr per week) was significantly correlated with serum creatinine (r = 0.48, P = 0.0001), serum albumin (r = 0.135, P = 0.0001) and BMI (r = 0.275, P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)