Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction
Kamyar Kalantar-Zadeh,Ryan D. Kilpatrick,Noriko Kuwae,Charles J. McAllister,Harry Alcorn,Joel D. Kopple,Sander Greenland +6 more
Reads0
Chats0
TLDR
Time-varying hypoalbuminaemia predicts all-cause and CV death differently from fixed measures of serum albumin in MHD patients, and an increase in serumalbumin over time is associated with better survival independent of baseline serum albumIn or other MICS surrogates.Abstract:
Background. Hypoalbuminaemia is a marker of malnutrition–inflammation complex syndrome (MICS) and a strong predictor of cardiovascular (CV) death in maintenance haemodialysis (MHD) patients. However, serum albumin may change over time. Hence, its time-varying associations with outcome may be different. Methods. Associations between 3-month averaged serum albumin levels, measured in a single laboratory using bromocresol green, and CV mortality were studied longitudinally in a 2-year cohort of 58 058 MHD patients. Mortality predictability of fixed baseline and trimonthly-varying serum albumin concentrations were compared. Results. Hazard ratios (HRs) of CV death strictly increased across decrements of baseline serum albumin, whereas the HR for time-varying serum albumin decrements below 3.8 g/dl did not differ. A drop in serum albumin in the first 6 months was associated with increasing all-cause and CV death risks in the subsequent 18 months, while a rise in serum albumin was a predictor of better survival independent of baseline serum albumin. The multivariate adjusted population-attributable fraction of death due to baseline serum albumin 3.8 g/dl might reduce the number of MHD deaths in the USA by � 10 000 annually. Nutritional interventions examining benefits of increasing serum albumin in MHD patients are urgently needed.read more
Citations
More filters
Journal ArticleDOI
A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease
Denis Fouque,Kamyar Kalantar-Zadeh,Joel D. Kopple,Noël Cano,Philippe Chauveau,Lilian Cuppari,Harold A. Franch,Gabriele Guarnieri,Talat Alp Ikizler,George A. Kaysen,Bengt Lindholm,Ziad A. Massy,William E. Mitch,E. Pineda,Peter Stenvinkel,A. Trevinho-Becerra,Christoph Wanner +16 more
TL;DR: An expert panel to review and develop standard terminologies and definitions related to wasting, cachexia, malnutrition, and inflammation in CKD and AKI recommends the term 'protein-energy wasting' for loss of body protein mass and fuel reserves.
Journal ArticleDOI
Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients
Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,N. Kuwae,Deborah L. Regidor,Deborah L. Regidor,Csaba P. Kovesdy,Ryan D. Kilpatrick,Ryan D. Kilpatrick,Christian S. Shinaberger,Christian S. Shinaberger,Charles J. McAllister,Matthew J. Budoff,Isidro B. Salusky,Isidro B. Salusky,Joel D. Kopple,Joel D. Kopple +15 more
TL;DR: Associations between high serum parathyroid hormone and increased death risk were masked by case-mix characteristics of MHD patients, and Administration of any dose of paricalcitol was associated with improved survival in time-varying models.
Journal ArticleDOI
Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis
Kamyar Kalantar-Zadeh,Deborah L. Regidor,Csaba P. Kovesdy,David B. Van Wyck,Suphamai Bunnapradist,Tamara B. Horwich,Gregg C. Fonarow +6 more
TL;DR: In he modialysis patients, greater fluid retention between 2 subsequent hemodialysis treatment sessions is associated with higher risk of all-cause and cardiovascular death.
Journal ArticleDOI
Associations Between Changes in Hemoglobin and Administered Erythropoiesis-Stimulating Agent and Survival in Hemodialysis Patients
Deborah L. Regidor,Joel D. Kopple,Csaba P. Kovesdy,Ryan D. Kilpatrick,Charles J. McAllister,Jason Aronovitz,Sander Greenland,Kamyar Kalantar-Zadeh +7 more
TL;DR: In this article, longitudinal associations between survival and quarterly (13-wk averaged) hemoglobin values and administered erythropoiesis-stimulating agents (ESA) dose in a 2-yr (July 2001 to June 2003) cohort of 58,058 maintenance hemodialysis patients from a large dialysis organization (DaVita) in the United States.
Journal ArticleDOI
ESPEN Guidelines on Parenteral Nutrition: Adult Renal Failure
Noël Cano,Michel Aparicio,Giuliano Brunori,Juan Jesus Carrero,Bruno Cianciaruso,Enrico Fiaccadori,Bengt Lindholm,Vladimir Teplan,Denis Fouque,Gabriele Guarnieri +9 more
TL;DR: From a metabolic point of view, patients with CKD or on chronic HD who develop a superimposed acute illness should be considered to be similar to patients with ARF, and the same principles in respect of PN should therefore be applied.
References
More filters
Journal ArticleDOI
The Statistical Analysis of Failure Time Data.
Journal ArticleDOI
Death Risk in Hemodialysis Patients: The Predictive Value of Commonly Measured Variables and an Evaluation of Death Rate Differences Between Facilities
Edmund G. Lowrie,Nancy L. Lew +1 more
TL;DR: Strategies designed to improve the overall mortality statistic for dialysis patients in the United States would be better directed toward improving the quality of care for all patients, particularly high-risk patients, within their usual treatment settings rather than trying to identify facilities with high death rate for possible regulatory intervention.
Journal ArticleDOI
Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Garabed Eknoyan,Gerald J. Beck,Alfred K. Cheung,John T. Daugirdas,Tom Greene,John W. Kusek,Michael Allon,James L. Bailey,James A. Delmez,Thomas A. Depner,Johanna T. Dwyer,Andrew S. Levey,Nathan W. Levin,Edgar L. Milford,Daniel B. Ornt,Michael V. Rocco,Gerald Schulman,Steve J. Schwab,Brendan P. Teehan,Robert D. Toto +19 more
TL;DR: Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.
Journal ArticleDOI
Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients
Kamyar Kalantar-Zadeh,Gladys Block,Gladys Block,Gladys Block,Michael H. Humphreys,Michael H. Humphreys,Michael H. Humphreys,Joel D. Kopple,Joel D. Kopple,Joel D. Kopple +9 more
TL;DR: An inverse association between conventional risk factors and clinical outcome in dialysis patients is found and it is possible that new standards or goals for such traditional risk factors as body mass, serum cholesterol, and blood pressure should be considered for these individuals.