The level of serum albumin is associated with renal prognosis and renal function decline in patients with chronic kidney disease

• Published in: BMC nephrology Vol. 24; no. 1; p. 57
• Main Authors: Cheng, Tong, Wang, Xiaoyu, Han, Yong, Hao, Jianbing, Hu, Haofei, Hao, Lirong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-03-2023; BioMed Central; BMC
• Subjects: Aged; Aged, 80 and over; Albumin; Analysis; Angina pectoris; Antihypertensives; Blood pressure; Body mass index; Cardiovascular disease; Care and treatment; Chronic kidney disease; Chronic kidney failure; Cohort analysis; Cox proportional hazards regression model; Creatinine; Development and progression; Diabetes; Dialysis; Disease Progression; Diuretics; Epidermal growth factor receptors; Etiology; Female; Glomerular Filtration Rate; Health aspects; Heart failure; Hemoglobin; Humans; Hypertension; Informed consent; Kidney; Kidney diseases; Kidney function tests; Linear regression model; Male; Measurement; Medical prognosis; Middle Aged; Missing data; Mortality; Nephrology; Patients; Prognosis; Prospective Studies; Proteins; Regression analysis; Renal Dialysis; Renal function; Renal function decline; Renal Insufficiency, Chronic - therapy; Renal prognosis; Risk Factors; Sensitivity analysis; Serum albumin; Serum Albumin - analysis; Urine; Variables; Japan; Cox proportional hazards regression model; Chronic kidney disease; Serum albumin; Renal function decline; Linear regression model; Renal prognosis
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-023-03110-8

The study's purpose is to explore the link of serum albumin on renal progression in patients with chronic kidney disease (CKD).
This study was a secondary analysis of a prospective cohort study in which a total of 954 participants were non-selectively and consecutively collected from the research of CKD-ROUTE in Japan between November 2010 and December 2011. We evaluated the association between baseline ALB and renal prognosis (initiation of dialysis or 50% decline in eGFR from baseline) and renal function decline (annual eGFR decline) using the Cox proportional-hazards and linear regression models, respectively. We performed a number of sensitivity analyses to ensure the validity of the results. In addition, we performed subgroup analyses.
The included patients had a mean age of (66.86 ± 13.41) years, and 522 (69.23%) were male. The mean baseline ALB and eGFR were (3.89 ± 0.59) g/dL and (33.43 ± 17.97) ml/min/1.73 m
. The annual decline in eGFR was 2.65 mL/min/1.73 m
/year. 218 (28.9%) individuals experienced renal prognosis during a median follow-up period of 36.0 months. The baseline ALB was inversely linked with renal prognosis (HR = 0.61, 95%CI: 0.45, 0.81) and renal function decline (β = -1.41, 95%CI: -2.11, -0.72) after controlling for covariates. The renal prognosis and ALB had a non-linear connection, with ALB's inflection point occurring at 4.3 g/dL. Effect sizes (HR) were 0.42 (0.32, 0.56) and 6.11 (0.98, 38.22) on the left and right sides of the inflection point, respectively. There was also a non-linear relationship between ALB and renal function decline, and the inflection point of ALB was 4.1 g/dL. The effect sizes(β) on the left and right sides of the inflection point were -2.79(-3.62, -1.96) and 0.02 (-1.97, 1.84), respectively.
This study shows a negative and non-linear association between ALB and renal function decline as well as renal prognosis in Japanese CKD patients. When ALB is lower than 4.1 g/dL, ALB decline was closely related to poor renal prognosis and renal function decline. From a therapeutic point of view, reducing the decline in ALB makes sense for delaying CKD progression.