Kalantar_edit.qxp 8/2/08 11:19 Page 40
Nutrition and Hypoalbuminuria
first infection-related hospitalisation had a severe outcome. The Similarly, in an observational cohort study of incident HD patients,
frequency of severe outcomes was inversely related to the serum patients who initiated treatment with low serum albumin levels had a
albumin level, increasing from 39.9% in patients with albumin levels significantly greater average number of hospital admissions than those
≥4.0g/dl to 82.7% among patients with a serum albumin <2.5g/dl (see with higher albumin levels (1.77±1.82 versus 0.72±0.96 admissions;
Figure 3). p=0.002).
53
Likewise, the length of hospital stay (8.96±9.96 versus
3.83±5.68 days; p=0.006) was also highest in those patients with the
lowest serum albumin levels. Hospitalisation costs were greatest for
patients in the lowest quartile of serum albumin (US$31,154±25,673)
Based on these data, it has been
compared with the highest quartile (US$24,394±26,077; p=0.517). A
estimated that correction of serum
significant negative correlation between treatment costs and serum
albumin levels (r=-0.338; p<0.01) was also reported by Salonen et al.
54
albumin levels in haemodialysis
patients with levels <4.0g/dl could
Summary
The data presented here suggest that HD patients with low levels of
potentially save 10,000 lives per year.
serum albumin are at a significantly increased risk of mortality and
hospitalisation, with prolonged hospital stays and substantially
increased healthcare costs. Accumulated evidence also supports the
The association between serum albumin levels and hospitalisation risk theory that an increase in serum albumin over time is associated with
was also evaluated in data from 77,205 HD patients from the Fresenius improved survival, independent of baseline albumin level, while
Medical Care North America (FMCNA) database.
52
Data showed a conversely a decrease in serum albumin over time correlates with
two-fold increase in death and hospitalisation risk with albumin increased cardiovascular death.
≤3.5g/dl compared with ≥4.0g/dl in this population (p<0.001).
Increasing serum albumin levels reduced this risk while, conversely, Data reported by Kalantar-Zadeh and co-workers suggest that the
decreasing serum albumin levels led to worse outcomes. Hence, in survival advantages conferred by serum albumin levels <3.8g/dl are
patients with serum albumin levels of <3.5g/dl (n=8,844) who were incremental such that a serum albumin ≥4.4g/dl is associated with
hospitalised during the study (n=7,783), a decline in serum albumin 48% higher survival and 40% lower risk of death compared with a
levels of >0.3g/dl increased the risk of hospitalisation by 41% serum albumin level <3.8g/dl. Based on these data, it has been
(p<0.05). In contrast, when serum albumin levels were increased by estimated that correction of serum albumin levels in HD patients with
>0.2g/dl the associated risk of hospitalisation decreased by 25%.
52
levels <4.0g/dl could potentially save 10,000 lives per year.
55
■
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40 EUROPEAN RENAL DISEASE 2007
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