Serum Albumin as a Predictor of Mortality in Peritoneal Dialysis: Comparisons With Hemodialysis

Abstract

Background Serum albumin predicts mortality in dialysis patients and is used to assess their health status and the quality of delivered care. Whether the threshold level of serum albumin at which mortality risk increases in peritoneal dialysis (PD) patients is the same as for hemodialysis (HD) patients has not been studied. Study Design Observational cohort study of dialysis patients undertaken to determine the survival-predictability of serum albumin in PD patients, and to compare it with that in HD patients. Setting and Participants 130,052 dialysis patients (PD, 12,171; HD, 117,851) who received treatment in any of the 580 dialysis units owned by DaVita Inc. between 7/1/2001 through 6/30/2006, followed through 6/30/2007 Predictor Baseline and time-averaged serum albumin (assayed by bromcresol green), and change in serum albumin over six months Outcome Measures All-cause, cardiovascular, and infection-related mortality. Results PD patients with baseline serum albumin < 3.0 g/dl had an over three-fold higher adjusted risk for all-cause and cardiovascular mortality, and 3.4-fold higher risk for infection-related mortality (reference group: serum albumin 4.00–4.19 g/dl). The adjusted all-cause mortality was significantly lower in PD patients with ≥ 0.3 g/dl increase in serum albumin over six months, and significantly higher in whom it decreased by ≥ 0.2 g/dl (reference group: serum albumin change, +0.1 to −0.1 g/dl). Significant increase in death risk was evident for HD patients with serum albumin < 4.0 g/dl but at < 3.8 g/dl for PD patients. For each albumin category, the overall death risk for PD patients was lower than of HD patients (reference group: HD patients with serum albumin, 4.00–4.19 g/dl). Limitations Study can only identify associations without attribution of causality and residual confounding cannot be excluded. Conclusions To conclude, serum albumin predicts all-cause, cardiovascular, and infection-related mortality in both PD and HD patients. However, the threshold at which risk for death increases varies by dialysis modality and this difference should be considered by agencies or organizations that set quality standards.

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

“…Several studies have shown that serum albumin is also an independent predictor of peritonitis in patients on PD (16,32). Hypoalbuminemia, a marker of malnutrition and inflammation, can also predict all-cause, cardiovascular, and infection-related mortality in patients on PD (33). In our study, we also showed that serum albumin was an independent predictor of mortality.…”

Dialysis Modality and Outcomes in Kidney Transplant Recipients

“…The creation of the national DaVita dialysis patient cohort has been described previously (15)(16)(17)(18)(19)(20)(21)(22). Demographic data and details of medical history were collected, with information on age, sex, race, type of insurance, marital status, presence of diabetes, height, body weight (to calculate averaged body mass index), dialysis modality (HD versus PD), and dialysis vintage.…”

Association of Hemoglobin and Survival in Peritoneal Dialysis Patients

“…The creation of the cohort has been described previously (14,15). To minimize measurement variability, all repeated measures for each patient during any given calendar quarter, (i.e., over a 13-week interval) were averaged and the summary estimate was used in all models.…”