Low prealbumin levels are independently associated with higher mortality in patients on peritoneal dialysis

Abstract

BackgroundPrealbumin, a sensitive marker for protein–energy status, is also known as an independent risk factor for mortality in hemodialysis patients. We investigated the impact of prealbumin on survival in incident peritoneal dialysis (PD) patients.MethodsIn total, 136 incident PD patients (mean age, 53.0 ± 15.8 years) between 2002 and 2007 were enrolled in the study. Laboratory data, dialysis adequacy, and nutritional parameters were assessed 3 months after PD initiation. Patients were classified into 2 groups according to prealbumin level: high prealbumin (≥ 40 mg/dL) and low prealbumin (< 40 mg/dL).ResultsThe patients in the low-prealbumin group were older and had more comorbidities such as diabetes and cardiovascular diseases compared with the patients in the high-prealbumin group. Mean subjective global assessment scores were lower, and the high-sensitivity C-reactive protein levels were higher in the low-prealbumin group. Serum creatinine, albumin, and transferrin levels; percent lean body mass; and normalized protein catabolic rate were positively associated, whereas subjective global assessment scores and high-sensitivity C-reactive protein levels were negatively associated with prealbumin concentration. During the median follow-up of 49 months, patients in the lower prealbumin group had a higher mortality rate. Multivariate analysis revealed that prealbumin < 40 mg/dL (hazard ratio, 2.30; 95% confidence interval, 1.14–4.64) was an independent risk factor for mortality. In receiver operating characteristic curves, the area under the curve of prealbumin for mortality was the largest among the parameters.ConclusionPrealbumin levels were an independent and sensitive predictor for mortality in incident PD patients, showing a good correlation with nutritional and inflammatory markers.

Association Between Comprehensive Nutritional Scoring System (CNSS) and Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients

“…In china, the number of ESRD patients receiving PD therapy is rapidly growing in recent years [37]. Patients on long-term dialysis have a significantly increased risk of mortality, and cardiovascular disease (CVD) and infection are most common causes of death in dialysis patients [38,39] have shown a variety of risk factors that predict the outcomes of dialysis patients, including age [40], sex [41], RRF [42], blood pressure [43,44], comorbidity [45], BMI [46][47][48][49], serum ALB [50,51], pre-ALB [52][53][54], TC [55][56][57][58], TG [59,60], VLDL [61], HB [62], Ca, P [63], PTH, ALP [64], UA [65,66], K, CRP [67], dialysis adequacy [68,69], incident peritonitis [70,71] and so on. Much effort has been done to maintain stable blood pressure, correct anemia and electrolyte disturbance as well as ensure dialysis adequacy and prevent peritonitis, in order to improve the long-term outcomes of dialysis patients.…”

Serum Albumin at Start of Peritoneal Dialysis Predicts Long-Term Outcomes in Anhui Han Patients on Continuous Ambulatory Peritoneal Dialysis: A Retrospective Cohort Study

“…In this research, the cardiovascular disease was defined as follows [10]: (1) congestive heart failure or atrial fibrillation; (2) coronary artery disease; and (3) cerebrovascular disease. The residual renal function at start of PD was evaluated by eGFR; eGFR was estimated using the simplified modification of diet in renal disease equation: eGFR (mL/min/1.73 m 2 ) = 186 × serum creatinine (mg/ dL) -1.154 × age (years) -0.203 × 0.742 (if female).…”

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

“…Overhydration is common among PD patients and related cardiovascular risk and death [27][28][29]. Prealbumin levels were an independent and sensitive predictor for mortality in incident PD patients, showing a good correlation with nutritional and in ammatory markers [16,30]. Thus, both OH and serum prealbumin are modi able risk factors for PDrelated peritonitis, which have predictive value for peritonitis in CAPD patients.…”

“…Beside, prealbumin (transthyretin) is a hepatic secretory protein used to assess malnutrition in PD patients, had a prognostic value of peritonitis and mortality in PD patients [15,16]. With the above reasons, we conducted this study to determine the frequency of peritonitis as well as assess OH and low serum prealbumin can predict peritonitis in peritoneal dialysis patients in Viet Nam.…”