Kidney disease

Systemic inflammation

Proportional hazards model

Multivariate analysis

Endocrinology

Hemodialysis

Peritoneal dialysis

Serum albumin

End stage renal disease

Inflammation

Internal medicine

Univariate analysis

Confidence interval

Hazard ratio

Medicine

Gastroenterology

Renal function

Albumin

C-reactive protein

Dialysis

Diabetes mellitus

PLoS ONE

Background The correlation of low serum albumin with mortality in patients with chronic kidney disease (CKD) is partly linked to its association with systemic inflammation. However, it is not clear to what extent albumin's correlation with mortality depends on concomitant systemic inflammation. Here we addressed this question in patients with CKD stage 5. Methods Serum albumin (S-Alb), systemic inflammation (high-sensitive C-reactive protein, hsCRP), cardiovascular disease (CVD) and nutritional status (subjective global assessment, SGA) were assessed at baseline in 822 patients: 523 incident dialysis patients, 212 prevalent hemodialysis (HD) and 87 prevalent peritoneal dialysis (PD) patients. Patients were divided into four groups according to hsCRP and S-Alb in each cohort: Group 1 –normal S-Alb and normal hsCRP (reference); Group 2 –low S-Alb and normal hsCRP; Group 3—normal S-Alb and high hsCRP; Group 4—low S-Alb and high hsCRP. Survival over 60 months was analyzed. Results In Cox analysis, Group 4 had an increased mortality risk (adjusted Hazard ratio (95% confidence interval): 1.62 (1.06–2.47); p = 0.02) whereas the augmented mortality risks for Groups 2 and 3 in univariate analyses were not significant after adjustments for age, gender, blood pressure, diabetes mellitus, smoking, SGA, renal function and renal replacement technique. Conclusions Whereas mortality risk was increased in CKD stage 5 patients with low S-Alb and high CRP, it was not increased in patients with low S-Alb and normal CRP. Our observation suggests that inflammatory status should be taken into account when using S-albumin for risk assessment in CKD stage 5 patients.

The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease