Clinical Significance of Albumin Slope in the Hemodialysis Patients

Choi, Kyu Bok; Lee, Young Sook

Abstract

BACKGROUND
Hypoalbuminemia is the well- known marker of morbidity and mortality in the dialysis population. An albumin concentration at a single time point may not be of help in predicting the outcome of an individual patient. The direction of change over time may offer better prediction. The aim of our study was to evaluate the clinical significance of the trends in serum albumin concentration over time. METHODS: We retrospectively studied 61 patients. Additionally 24 patients were excluded in this study with an admission history during last one year and clinically apparent acute/chronic infection. The albumin slope (AS: g/dL/mon) was obtained from monthly measured serum albumin levels from September 2001 to August 2002 by method of least squares. RESULTS: AS was negatively correlated with hs- CRP (r=-0.530, p=0.000) and positively correlated with TCO2 (r=0.272, p=0.034), but not correlated with age, dialysis duration, wKt/V, nPCR and Hb. When the studied population was divided according to the albumin slope to group I (n=45, AS > or =+0.01, lASl <0.01) and group D (n=16, AS < or =-0.01), dialysis duration was longer and iPTH was higher in the group I than in group D (52.3+/-40.3 vs 32.8+/-18.9, p<0.05; 98.1+/-110.9 vs 46.4+/-30.7, p<0.01, respectively). AS was higher in group I than in group D (0.015+/-0.012 vs -0.026+/-0.023, p<0.001); hs-CRP tended to be higher in group D but did not reach statistical significance (1.78+/-2.81 vs 0.44+/-1.08; p=0.08). When it comes to Ca, P, Mg and TCO2, there was no difference between the groups. Compared to initial 3 months, last 3 months showed a significant increase of serum creatinine (10.3+/-3.0 vs 10.9+/-2.8, p<0.01) and a significant decrease of serum TCO2 (23.7+/-3.2 vs 20.8+/-2.2, p<0.001) in group I with no change in group D. CONCLUSION: Slope of albumin over time, even if its degree is clinically negligible, can offer valuable information about the patient's status that is not apparent.