Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

Abstract

Introduction: Although low serum albumin (ALB) may worsen acute kidney injury (AKI), additional study is needed to establish the connection between ALB and the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT).Methods:A secondary analysis of a bi-center, retrospective, and observational study, such as critically ill patients with AKI and treated with CRRT from January 2009 to September 2016. The univariate analysis, multi-factor regression analysis, sensitivity analysis, and curve-fitting analysis were applied to explore the association of ALB with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT, and the removal efficiency of serum phosphorus.Results: From January 2009 to September 2016, 1,132 cases with AKI and treated with CRRT met the inclusion criteria and enrolled in this study. We found that the higher ALB before CRRT, the lower the 28- and 90-day mortality of patients with AKI and treated with CRRT, the higher removal efficiency of serum phosphorus, the adjusted hazard ratio (HR) value for 28-day mortality in the four models were separately 0.92 (0.90, 0.95), 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.95); the adjusted HR value for 90 day mortality in the four models were 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.96); the adjusted OR value for the removal efficiency of serum phosphorus in the four models were separately −0.04 (−0.07, −0.01), −0.05 (−0.08, −0.01), −0.04 (−0.08, −0.01), and −0.04 (−0.08, −0.01). The sensitivity analysis and curve-fitting analysis also showed that ALB before CRRT was correlated with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT and the removal efficiency of serum phosphorus.Conclusion: The higher the serum ALB before CRRT, the lower the mortality of critically ill patients with AKI and treated with CRRT, and the higher the clearance efficiency of serum phosphorus.

Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study

“…In multivariate analysis, the HRs of initial hypoalbuminemia for 28-day and 90-day mortality were 0.63 (0.50–0.80) and 0.63 (0.51–0.78), respectively. The association between hypoalbuminemia and mortality was verified by Lv et al [ 6 ] in a retrospective review of 1132 AKI patients who required CRRT; their results showed HRs for 28-day mortality and 90-day mortality of 0.92 (0.89–0.95) and 0.92 (0.89–0.96), respectively.…”

“…Similar trends were observed in previous studies. In Lv et al [ 6 ], the proportions of myocardial infarction and congestive heart failure were higher, while the mean SOFA score was lower, in the group with serum albumin ≥ 3 g/dL than in the group with serum albumin < 3 g/dL. Moon et al [ 8 ] showed that the proportion of patients with diabetes was higher, while the mean APACHE II score was lower, in the third tertile of albumin compared to the other tertiles.…”

“…Hypoalbuminemia has been reported in 73.9% of critically ill patients who require continuous renal replacement therapy (CRRT) [ 6 , 7 ]. Several studies have reported that hypoalbuminemia at the initiation of CRRT is a prognostic marker for short- and long-term mortality [ 6 , 8 , 9 ]. However, little is known regarding the clinical importance of changes in serum albumin during CRRT.…”

Supplementation of serum albumin is associated with improved pulmonary function: NHANES 2013–2014

“…Serum albumin is related to cerebral ischemia ( Turhan et al, 2006 ), Alzheimer’s disease ( Skillbäck et al, 2017 ; Bode et al, 2018 ; Kim et al, 2020 ), Crohn’s disease ( Su et al, 2019 ), liver cirrhosis ( Chen et al, 2011 ; Oettl et al, 2013 ; Arroyo et al, 2014 ), chronic heart failure ( Jabbour et al, 2014 ), acute kidney injury ( Bang et al, 2018 ; Thongprayoon et al, 2018 ; Lv et al, 2021 ), chronic kidney disease ( Stoycheff et al, 2009 ; Zhang et al, 2015 ) and other diseases; however, the relationship between serum albumin and pulmonary function is unclear. Several studies have shown that in some acute respiratory diseases that lead to reduced pulmonary function, such as acute respiratory distress and acute lung, serum albumin increases capillary permeability, causing it to leak from blood vessels into tissue fluid or to escape into the alveolar space, resulting in reduced serum albumin levels ( Fanali et al, 2012 ).…”

The association between albumin corrected anion gap and ICU mortality in acute kidney injury patients requiring continuous renal replacement therapy

“…Hypoproteinemia, indeed, is very common in critically ill patients. Moreover, previous studies reported that hypoalbuminemia at the initiation of CRRT [ 9 ], as well as the dynamic changes of albumin during CRRT [ 10 ], are important risk factors for poor prognosis in AKI patients. Therefore, the formula of calculating the albumin corrected anion gap (ACAG) is described by Figge J et al in 1998 to correct the AG for fluctuations in the albumin concentration [ 11 , 12 ].…”