Lower serum albumin level is associated with increased risk of hospital admission and length of stay in hospital among incident hemodialysis patients by using overdispersed model

Abstract

Serum albumin is a major determinant of hospitalization in patients with end‐stage renal disease (ESRD). Previous reports generally use the Poisson model to evaluate the relationships between outcome and response variables. However, hospitalization data are often overdispersed, and few studies using appropriate methods exist in the literature.This retrospective cohort study included 426 patients with ESRD receiving hemodialysis treatment between 2014 and 2018. Using a negative binomial regression model with hierarchical multivariable adjustments, we investigated the relationship between serum albumin, hospital admissions, and total hospitalization days. Mean age and mean baseline serum albumin levels were 64.7 ± 11 years and 3.5 ± 0.5 g/dL, respectively. At least one hospitalization was identified in 402 (94%) patients. The incidence rate was 1.48 (95% CI, 1.41‐1.56) admissions per patient‐year during the follow‐up period of 5 years. A negative linear association was observed between serum albumin and hospitalization frequency. Hospitalization rates (95% CI) were 1.81 (1.65‐1.98), 1.44 (1.3‐1.59), 1.36 (1.22‐1.51), and 1.33 (1.2‐1.48) per patient‐year in serum albumin levels ≤3, 3.1 to ≤3.3, 3.4 to ≤3.7, and ≥3.8 g/dL, respectively. Case mix‐adjusted incidence rate ratio was 0.82 (95% CI, 0.70‐0.94), while it was robust to further adjustments for malnutrition and inflammation markers. Similar results were observed in hospitalization days and time to the first hospitalization. These findings, which result from the negative binomial model using overdispersed data, suggest that lower serum albumin is related to increased hospitalization rates and hospital days in incident hemodialysis patients.

Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status

“…Serum albumin levels were lower in people with versus without diabetes. Reduced serum albumin levels have been shown to indicate malnutrition risk in people on haemodialysis; additionally, they serve as a powerful predictor of mortality risk in this population 21 . It has been proposed that factors causing low albumin levels, rather than hypoalbuminaemia per se, may be associated with high mortality and morbidity in people on haemodialysis 6 .…”

Early albumin level and mortality in hemodialysis patients: a retrospective study

“…However, a low ALB level could damage the body's natural defense mechanisms, including homeostasis of steroid hormones and calcium, anatomic barriers, and even the pharmacological activity of drugs (25). Lower ALB is related to increased rates of hospitalization and number of hospital days in incident HD patients (26).…”

Predictive role of fluctuating biochemical parameters for mortality in hemodialysis patients

“…In quarters 4. 14 r s = À0.29), whereas the correlation in quarter 3.16 was moderate (r s = À0.35). We also identified a positive correlation between albumin and uric acid and creatinine, respectively.…”

“…Hypoalbuminemia is associated with increased mortality and hospitalization rates in patients requiring dialysis [12][13][14]. Elevated C-reactive protein (CRP) seems to be a strong predictor of decreased albumin levels, as it is the best marker of chronic inflammation [15].…”