Clinical Investigation

Kidney International (1993) 44, 115–119; doi:10.1038/ki.1993.220

Serum albumin is a strong predictor of death in chronic dialysis patients

Kunitoshi Iseki1, Nobuyuki Kawazoe1 and Koshiro Fukiyama1

1Third Department of Internal Medicine, School of Medicine, University of The Ryukyus, Okinawa, Japan

Correspondence: Dr Kunitoshi Iseki MD, Third Department of Internal Medicine, University of The Ryukyus, 207 Uehara, Okinawa 903-01, Japan.

Received 8 September 1992; Revised 3 February 1993; Accepted 4 February 1993.

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Abstract

Serum albumin is a strong predictor of death in chronic dialysis patients. 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). Serum albumin was found to be a strong predictor of death in chronic hemodialysis patients. Causes of low serum albumin should be carefully evaluated if underlying illness is not evident.

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