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

Abstract

Background Hypoalbuminemia at the initiation of continuous renal replacement therapy (CRRT) is a risk factor for poor patient outcomes. However, it is unknown whether the patterns of changes in serum albumin levels during CRRT can be used to predict patient outcomes. Methods This retrospective study analyzed data that had been consecutively collected from January 2016 to December 2020 at the Third Affiliated Hospital. We included patients with acute kidney injury who received CRRT for ≥ 72 h. We divided the patients into four groups based on their serum albumin levels (albumin ≥ 3.0 g/dL or < 3.0 g/dL) at the initiation and termination of CRRT. Results The 793 patients in this study were categorized into the following albumin groups: persistently low, 299 patients (37.7%); increasing, 85 patients (10.4%); decreasing, 195 patients (24.6%); and persistently high, 214 patients (27.1%). In-hospital mortality rates were highest in the persistently low and decreasing groups, followed by the increasing and persistently high groups. The hazard ratio for in-hospital mortality was 0.481 (0.340–0.680) in the increasing group compared to the persistently low group; it was 1.911 (1.394–2.620) in the decreasing group compared to the persistently high group. The length of ICU stay was 3.55 days longer in the persistently low group than in the persistently high group. Conclusions Serum albumin levels changed during CRRT, and monitoring of patterns of change in serum albumin levels is useful for predicting in-hospital mortality and the length of ICU stay.

Association of Hypoalbuminemia within Hospital Mortality in Patients with Acute Decompensated Heart Failure

“…This association persisted even after adjustment for potential confounders like age, sex, and comorbidities, with an adjusted HR of 2.0 (14). These results align with previous research, reinforcing the notion that hypoalbuminemia is not merely a marker of malnutrition but also indicative of inflammation and systemic organ dysfunction, which can exacerbate the severity of heart failure and its associated comorbidities (15,16).…”

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 ].…”

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

“…We performed CRRT in continuous veno-venous hemodia ltration mode. The details of our CRRT methods are described elsewhere 28,29 . A decision to stop CRRT was made by a nephrologist when signs of renal recovery were observed, the volume of spontaneous urine output increased by > 200-500 mL/day, or the disease burden was to an extent that it could be controlled by the patient 30 .…”