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Association of the serum albumin level with prognosis in chronic kidney disease patients

  • Nephrology - Original Paper
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Abstract

Purpose

Chronic kidney disease (CKD) is an important contributor to the overall morbidity and mortality due to noncommunicable diseases. We investigated the relationship between serum albumin and the clinical prognosis in patients with stage G2–G5 CKD who were not undergoing dialysis.

Methods

This was a post hoc analysis of 1138 patients enrolled from 2010 to 2011 in the Chronic Kidney Disease Research of Outcomes in Treatment and Epidemiology (CKD-ROUTE) study. The primary endpoints were CKD progression, cardiovascular disease (CVD) development, and all-cause mortality. Cox proportional hazards models were used.

Results

During a median follow-up time of 35 months, the number of patients who experienced CKD progression, CVD development, and all-cause mortality was 278 (24.7%), 116 (10.3%), and 78 (6.9%), respectively. In multivariable-adjusted Cox proportional hazards models, the adjusted hazard ratios (HRs) for CKD progression, CVD development, and all-cause mortality in patients with the highest quartile of serum albumin concentrations compared to those with the lowest quartile of serum albumin concentrations were 0.13 (P < 0.0001), 0.29 (P = 0.0002), and 0.27 (P = 0.0009), respectively, in the model adjusted for demographic factors, hypertension, diabetes, and a history of CVD. After further adjustment for the estimated glomerular filtration rate (eGFR), urinary protein/creatinine ratio (UPCR), and systolic blood pressure (SBP), the results remained significant (HR for CKD progression 0.37, P < 0.0001; HR for CVD development 0.41, P = 0.0120; HR for all-cause mortality 0.37, P = 0.0158).

Conclusion

Serum albumin levels were inversely associated with the risks of CKD progression, CVD development, and all-cause mortality among patients with stage G2–G5 CKD who were not undergoing dialysis.

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Acknowledgements

We gratefully acknowledge Iimori Soichiro, Naito Shotaro, Noda Yumi, Sato Hidehiko, Nomura Naohiro, Sohara Eisei, Okado Tomokazu, Sasaki Sei, Uchida Shinichi, Rai, and Tatemitsu for the data of this study.

Funding

This work was supported in part by the research project of Shenzhen Key Medical Discipline Construction Fund, no. SZXK009; Sanming Project of Medicine in Shenzhen, no. SZSM201512004; Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project, no. 20203357003 and no. 20213357018.

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Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, 518035, Guangdong, China

    Haiying Song, Cuimei Wei, Haofei Hu & Qijun Wan

  2. Department of Nephrology, Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China

    Haiying Song, Cuimei Wei, Haofei Hu & Qijun Wan

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  1. Haiying Song
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Contributions

HS, HH, and QW contributed to the study concept and design, researched and interpreted the data, and drafted the manuscript. CW researched data and reviewed the manuscript and oversaw the progress of the project, contributed to the discussion, and reviewed the manuscript. HS, HH, QW are the guarantors of this work and, as such, had full access TO all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Haofei Hu or Qijun Wan.

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Conflict of interest

The authors declare no conflict of interest.

Institutional review board statement

The study of the data are available from the Dryad repository (https://doi.org/10.5061/dryad.kq23s) and the data were approved by the ethical committees of Tokyo Medical and Dental University, School of Medicine (No. 883) and all institutions participating in the study and were conducted in accordance with the ethical principles of the Declaration of Helsinki.

Informed consent statement

All patients in this study were provided with the description of investigations, although this study was conducted as a medical record-based retrospective analysis and the included subjects were anonymized.

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Song, H., Wei, C., Hu, H. et al. Association of the serum albumin level with prognosis in chronic kidney disease patients. Int Urol Nephrol 54, 2421–2431 (2022). https://doi.org/10.1007/s11255-022-03140-5

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