Relationship between serum protein and mortality in adults on long-term hemodialysis: Exhaustive review and meta-analysis

Herselman, Marlien; Esau, Nazeema; Kruger, Jeanne-Marie; Labadarios, Demetre; Moosa, Mohammed Rafique

doi:10.1016/j.nut.2009.07.009

Cited by 84 publications

(86 citation statements)

References 47 publications

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“…This is in line with a publication of Ladhani et al [33], who summarized data from 165 studies and came to the conclusion, that obesity may be protective in pre- and hemodialysis patients, not however in transplant recipients. Similarly, serum levels of albumin have been described to be inversely related to all-cause mortality with significantly greater effects in studies of shorter duration, with larger sample sizes and in patients of younger compared to patients of older age [37]. In our study, the strength of this inverse association is underscored by the fact that one baseline BMI and albumin measurement is associated with mortality even during a median follow-up period of 11.5 years.…”

Section: Discussionsupporting

confidence: 58%

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

et al. 2018

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Background: Data concerning long-term mortality predictors among large, purely diabetic hemodialysis collectives are scarce. Methods: We used data from a multicenter, prospective, randomized trial among 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) and its observational follow-up study. The association of 10 baseline candidate variables with mortality was assessed by Cox proportional hazards regression. Results: Overall, 103 participants survived the median follow-up of 11.5 years. Significant predictors of mortality were age (hazard ratio [HR] 1.03, 95% CI 1.02–1.04), cardiovascular (HR 1.42, 95% CI 1.25–1.62) and peripheral vascular disease (HR 1.55, 95% CI 1.36–1.76), higher hemoglobin A1c (HbA1c; HR 1.08, 95% CI 1.03–1.14), and loss of self-dependency (HR 1.20, 95% CI 1.03–1.39). Higher albumin (HR 0.72, 95% CI 0.59–0.89) and body mass index (BMI; HR 0.98, 95% CI 0.96–0.99) had protective associations. There was no significant association with sex, diabetes duration, and cerebrovascular diseases. Subgroup analyses by age and diabetes duration showed stronger associations of cardiovascular disease, HbA1c, albumin, BMI, and loss of self-dependency in younger patients and/or shorter diabetes duration. Loss of self-dependency and energy resources (albumin, BMI) increased mortality more severely in women, whilst the impact of cardiovascular and peripheral vascular diseases was more pronounced in men. Conclusion: Long-term mortality risk in patients with T2DM on hemodialysis was associated with higher age, vascular diseases, HbA1c, loss of self-dependency, and low energy resources. Interestingly, it does not vary between sexes. Further individualized prognosis estimation and therapy should strongly depend on age, diabetes duration, and gender.

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Section: Discussionsupporting

confidence: 58%

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

et al. 2018

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“…An increase in albumin by 1 g/dl was associated with an increase in vitality score by 7.7 points and 21% decrease in risk of death. Hypoalbuminemia, which is a marker of malnutrition-inflammation complex syndrome and a strong predictor of poor quality of life and cardiovascular death [22,23,24,25], may also similarly affect fatigue in maintenance HD patients. These findings are consistent with reports demonstrating that dialysis patients with laboratory evidence of malnutrition and/or inflammation have low levels of physical activity, higher fatigue and mortality [1,2,8,26].…”

Section: Discussionmentioning

confidence: 99%

Impact of Fatigue on Outcomes in the Hemodialysis (HEMO) Study

et al. 2011

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Background: Fatigue is a common debilitating symptom in chronic kidney disease patients on maintenance hemodialysis. However, little is known about its pathogenesis and association with survival. Methods: This study examines the correlates and outcomes of fatigue among 1,798 hemodialysis patients enrolled in the HEMO study. Fatigue was assessed using the SF-36 vitality scale. Multivariable analysis was used to assess independent associations of demographic and clinical characteristics with baseline fatigue and longitudinal changes in fatigue. The association of fatigue with all-cause and cause-specific mortality and cardiac hospitalizations was also assessed. Results: Higher index of coexistent diseases (ICED) score, diabetes, non-African-American race, lower serum albumin, use of medications for sleep and poor sleep quality were found to be significantly associated with more fatigue at baseline. In longitudinal analyses, patients who were older, had been on dialysis longer, had higher ICED score, and reported using medications for sleep were more likely to experience worsening fatigue, whereas higher serum albumin was strongly associated with an improvement in level of fatigue. A 10-point increase in vitality score was associated with 10% increase in mean survival (p < 0.0001). Conclusions: Demographic and clinical factors have significant associations with fatigue, which itself predicts mortality. Improving fatigue in the end-stage renal disease population may positively impact patient well-being and survival.

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“…A recent meta-analysis of 38 studies (265,330 patients) demonstrated a significant inverse correlation between serum albumin levels and all-cause mortality and cardiovascular mortality, whereas the serum CRP level was weakly but significantly correlated with all-cause mortality, but not with cardiovascular mortality 22) . Based on the results of the meta-analysis it was concluded that the potential adverse effects of malnutrition and infection in relation to mortality highlight the need for continued treatment of infections and correction of malnutrition in HD patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Serum Albumin, Serum C-Reactive Protein, and Pulse Wave Velocity as Predictors of the 4-Year Mortality of Chronic Hemodialysis Patients

Amemiya

Ogawa

Otsuka

et al. 2011

JAT

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Aim:Although serum albumin and C-reactive protein (CRP) levels and pulse wave velocity (PWV) are known to be associated with the clinical outcome of hemodialysis (HD) patients, it is unknown which of these parameters are more predictive of the long-term mortality of such patients. Methods: We measured biochemical parameters, including serum albumin and CRP, and the PWV of 202 patients on maintenance HD therapy and followed their course for 4 years, and 186 of the patients were enrolled in the current study analyses. We divided the 186 patients into three tertiles according to their serum albumin and CRP levels and PWV values, and conducted multivariate analyses to examine the impact of the tertiles on 4-year mortality. Results: Twenty-three (12.4%) patients died during the follow-up period, and the serum albumin of the group that died was significantly lower than in the group that survived, but the CRP levels and PWV were significantly higher in the group that died. The results of Kaplan-Meier analyses revealed a significantly higher risk of all-cause mortality in HD patients with higher CRP based on the results of Cox proportional hazards analyses; however, the serum albumin and PWV values were not associated with all-cause mortality. Conclusion:The results of this study suggest that serum CRP levels are a better mortality predictor than serum albumin or PWV values of chronic HD patients.

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Relationship between serum protein and mortality in adults on long-term hemodialysis: Exhaustive review and meta-analysis

Cited by 84 publications

References 47 publications

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

Impact of Fatigue on Outcomes in the Hemodialysis (HEMO) Study

Comparison of Serum Albumin, Serum C-Reactive Protein, and Pulse Wave Velocity as Predictors of the 4-Year Mortality of Chronic Hemodialysis Patients

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