scholarly journals Predictors of mortality in hemodialysis patients.

1993 ◽  
Vol 3 (9) ◽  
pp. 1613-1622 ◽  
Author(s):  
P Goldwasser ◽  
N Mittman ◽  
A Antignani ◽  
D Burrell ◽  
M A Michel ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Mortality Risk ◽  
Treatment Time ◽  
Cox Model ◽  
Hemodialysis Patients ◽  
The Other ◽  
Baseline Serum ◽  
Increased Risk ◽  
Risk Predictor ◽  
Low Serum

Serum biochemical measures suggestive of undernutrition have been reported to correlate with 1-yr mortality risk in prevalent groups of hemodialysis patients. The predictive power of these variables has not been reported in newly diagnosed patients or in patients whose dialysis prescription is guided by urea kinetics. The relationship of these predictors to mortality over periods of longer than 1 yr is also unreported. Therefore, the survival of 184 hemodialysis patients was examined for up to 44 months (1987 to 1991) with the Cox proportional hazards model. Baseline demographic, clinical, and biochemical parameters were used as independent variables. To adjust for bias in patient selection, the survival of patients with 12 months or less of prior dialysis at the time of enrollment ("new cases") was analyzed separately from that of patients with more than 1 yr of prior treatment ("long-standing cases"). Serum albumin was less than 3.5 g/dL in 31% of new cases and in 12% of long-standing cases. Adjusting for the other variables, low serum albumin was the strongest mortality risk predictor in both new and long-standing cases. Low serum cholesterol was an independent risk predictor in both groups. Diabetes and race were not significant predictors. Mean age at enrollment was nearly a decade higher for nonsurvivors than for survivors, in both new and long-standing groups. Yet, age was not an independent risk predictor in the Cox model for the new group because of an unexpectedly high death rate among young black men. Female gender, which was confounded by increased age, took the place of age in the model for the new group. For each model, there was good agreement between observed and predicted mortality for up to 24 months. To assess the influence of dialysis treatment time and dose (measured as pre-to-post treatment urea ratio) on risk, survival was examined in a subset of 139 patients monitored for up to 22 months, from 1989 to 1991, a period when the urea ratio was used routinely. Adjusting for the other variables, low serum albumin and cholesterol again independently increased risk. The urea ratio was also a significant independent predictor. The pattern of mortality by urea ratio was U shaped, with minimum risk for values between 2.5 and 3.4 Treatment time did not influence risk. It was concluded that baseline serum values of albumin and cholesterol strongly influence survival for up to 2 yr in new and long-standing hemodialysis patients.(ABSTRACT TRUNCATED AT 400 WORDS)

scholarly journals Serum Albumin and Future Risk of Hip, Humeral, and Wrist Fractures in Caucasian Men: New Findings from a Prospective Cohort Study

2019 ◽  
Vol 28 (5) ◽  
pp. 401-409 ◽  
Author(s):  
Setor K. Kunutsor ◽  
Ari Voutilainen ◽  
Michael R. Whitehouse ◽  
Samuel Seidu ◽  
Jussi Kauhanen ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Area Under The Curve ◽  
Fracture Prevention ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Baseline Serum ◽  
Increased Risk ◽  
New Findings ◽  
Caucasian Men ◽  
Low Serum

Objective: Low serum albumin concentration is associated with poor health outcomes, but its relationship with the risk of fractures has not been reliably quantified. We aimed to assess the prospective association of serum albumin with the risk of fractures in a general population. Subjects and Methods: Baseline serum albumin concentrations were measured in 2,245 men aged 42–61 years in the Kuopio Is­chemic Heart Disease study. Hazard ratios (HRs) (95% confidence intervals) were calculated for incident fractures. Results: A total of 121 fractures (hip, humeral, or wrist) were recorded during a median follow-up of 25.6 years. The risk of fractures increased linearly below a serum albumin concentration of ∼48 g/L. The age-adjusted HR (95% CI) for fractures per 1 standard deviation lower serum albumin was 1.24 (1.05–1.48). On further adjustment for several conventional and emerging risk factors, the HR was attenuated to 1.21 (1.01–1.45). Comparing the bottom versus top quartile of serum albumin levels, the corresponding adjusted HRs were 2.48 (1.37–4.48) and 2.26 (1.23–4.14). The association of serum albumin with fracture risk did not differ substantially according to age, body mass index, blood pressure, physical activity, alcohol consumption, socioeconomic status, inflammation, prevalent diseases, and smoking. Serum albumin at a threshold of 41.5 g/L demonstrated an area under the curve of 0.5850. Conclusion: In middle-aged Caucasian men, low serum albumin is associated with an increased risk of future fractures. The potential relevance of serum albumin concentrations in fracture prevention and prediction deserves further evaluation.

scholarly journals Gender-Related Differences and Mortality Predictors among Egyptian Hemodialysis Patients: A Multi-Center Prospective Observational Study

2020 ◽  
pp. 118-130
Author(s):  
Abir Farouk Megahed ◽  
Mona Mohammed Tawfik Abdelhady ◽  
Ghada El Kannishy ◽  
Nagy Sayed- Ahmed
Keyword(s):  
Mortality Rate ◽  
Serum Albumin ◽  
Mortality Risk ◽  
Hemodialysis Patients ◽  
Cross Sectional ◽  
Male Predominance ◽  
Patients With Diabetes ◽  
One Year ◽  
Stage Renal Disease ◽  
Low Serum

Background: End-stage renal disease (ESRD) is an important cause of global morbidity and mortality affecting both sexes. Both genders may present with different symptoms and signs, respond differently to therapy and may exhibit different degrees of tolerance towards their disease. In Egypt, hemodialysis (HD) constitutes the most common modality of renal replacement therapy and the number of hemodialysis patients is increasing. The objective of the present study was to investigate gender-related differences in clinical and biochemical characteristics in HD patients. Mortality events in both genders were also recorded and predictors of mortality in the included HD population were explored. Methods: This multicenter study adopted essentially a cross-sectional design and included 2158 patients (1241 males and 917 females) undergoing HD in 25 hemodialysis units in six governorates in Egypt. The study started at June 2016 till May 2017. Data were extracted from the patients' records. One year mortality events in the included HD patients were prospectively observed and recorded. Results: Males on HD had a significantly lower body mass index (BMI) values and were less efficiently dialyzed. Their blood pressure measurements were significantly higher. In addition, males had significantly higher serum albumin with a significantly lower serum potassium level. The overall mortality rate was 6.9% (149 deaths) during the one year follow up period with a significant male predominance (7.9% in males vs. 5.6% in females p=0.03). The mortality rate was highest within the first 14 months after starting hemodialysis therapy. Mortality was statistically significantly higher in patients with diabetes, ischemic heart disease (IHD), anemia with low hemoglobin, and low serum albumin. The mortality risk is nearly duplicated in HD patients with IHD, while low serum albumin was associated with about 3 times an increase in mortality risk in the studied HD patients.  Conclusion: Gender differences in clinical and laboratory characteristics and mortality do exist in Egyptian HD patients and should be considered when management guidelines are developed to suit the gender-related variations.

FP634HIGH ALL CAUSE AND CVD MORTALITY IN AN INCIDENT COHORT OF HEMODIALYSIS PATIENTS WITH LOW SERUM ALBUMIN AND INFLAMMATION

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i257-i257
Author(s):  
Abdul Rashid Qureshi ◽  
Jürgen Floege ◽  
Kai-Uwe Eckardt ◽  
Marc Froissart ◽  
Florian Kronenberg ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Hemodialysis Patients ◽  
Incident Cohort ◽  
Low Serum ◽  
Cvd Mortality

P1406A CASE-CONTROL STUDY ON RISK FACTORS OF CALCIPHYLAXIS: DATA FROM CHINESE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yuqiu Liu ◽  
Xiaotong Xie ◽  
Canlin Yang ◽  
Xin Yang ◽  
Xiao liang Zhang
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Chinese Population ◽  
Warfarin Therapy ◽  
Hemodialysis Patients ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Significant Difference

Abstract Background and Aims Calciphylaxis (CUA) is a rare but potentially fatal disease that is commonly occurred in dialysis patients. Since there is no data based on Chinese population, the study is aimed to investigate risk factors of CUA in Chinese hemodialysis patients. Method We retrospectively evaluated medical records of 20 hemodialysis patients who were newly diagnosed with CUA by skin biopsy admitted to Zhongda Hospital Southeast University from Oct.2017 to Dec.2018. Non-CUA dialysis patients with the same age and duration of dialysis were randomly selected as controls (Ratio=1:2). Results Most of CUA patients were male (80%) and elderly (55%), while 50% had a body mass index higher than 24. The mean time interval since start of dialysis to CUA diagnosis was 114.65±81.32 months, and the median time from appearance of skin lesion to diagnosis was 6 (2, 15) months. The incidence of hyperparathyroidism was higher in patients with CUA (80% vs 62.5%), but the differences of duration of elevated serum intact parathyroid hormone (iPTH) and its highest value were not significant compared with the controls. Warfarin therapy had no significant difference between two groups (15% vs 5%). Univariate logistic regression analysis indicated that male (OR 3.619, 95%CI 1.027-12.748), each 1 point increase in score of use of vitamin D and its analogues (OR 1.505, 1.029-2.201), each 1 mmol/L increase in corrected serum calcium level (OR 24.486, 1.570-381.873), each 1 mmol/L increase in serum phosphate level (OR 5.382, 1.767-16.389), each 1 pg/mL increase in iPTH level (OR 1.002, 1.000-1.003), each 1 g/L decline in serum albumin level (OR 1.181, 1.041-1.340), each 1 IU/L increase in serum alkaline phosphatase (ALP) level (OR 1.005, 1.000-1.009) and each 1 mg/L increase in hypersensitive c-reactive protein level (OR 1.029, 1.000-1.059) were significantly associated with CUA. Serum phosphate, albumin and ALP were still significant risk factors after multivariate analysis. Conclusion This is the first report of risk factors of CUA based on Chinese population. The results show that high levels of serum phosphate and ALP, low level of serum albumin are independent risk factors of CUA in Chinese hemodialysis patients. Unlike previous research from western countries, warfarin therapy didn’t show an increased risk in this study, propably because of the low exposure rate of it in China.

Perioperative outcomes following surgical resection of renal cell carcinoma with upper level IVC thrombus: A contemporary multicenter experience.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 498-498
Author(s):  
Edwin Jason Abel ◽  
R. Houston Thompson ◽  
Vitaly Margulis ◽  
Jennifer E. Heckman ◽  
Megan M. Merrill ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Perioperative Outcomes ◽  
Hepatic Veins ◽  
Complication Rates ◽  
Perioperative Mortality ◽  
Major Complications ◽  
Increased Risk ◽  
Ivc Thrombus ◽  
Upper Level ◽  
Low Serum

498 Background: Surgery for RCC patients with IVC thrombus above the hepatic veins is complex and associated with an increased risk of perioperative morbidity and mortality. However, minimal data exist that describe contemporary perioperative outcomes at major referral centers or the prognostic factors associated with adverse surgical outcomes. The objective of this study is to determine the preoperative predictors of major complications and 90 day mortality after surgery in RCC patients with IVC thrombus above the hepatic veins. Methods: Records were reviewed of all RCC patients with IVC tumor thrombus above hepatic veins who had surgery from 1/2000 to 12/2012 at Mayo Clinic, MD Anderson, UT Southwestern and the University of Wisconsin. Major complications were recorded were defined as 3A or greater according to the Clavien- Dindo system within 90 days of surgery. Univariate and multivariate (MV) analyses were used to evaluate associations of preoperative clinical, pathological or laboratory variables with risk of major complications or 90-day mortality. Results: A total of 162 patients were identified for study (thrombus level 3,4 in 69 and 93 patients, respectively, according to Neves classification). Cardiopulmonary bypass was used in 60/162 (37.5%), while 40 (24.7%) patients underwent pre-operative angioembolization. Major complications were reported in 55 (34.0%) patients, with the most common being respiratory (12.4%), hematologic (9.2%) and cardiac (8.6%). On MV analysis, preoperative systemic symptoms and level 4 thrombus were independently associated with an increased risk of major complications. Mortality was reported in 17 (10.5%) patients within 90 days after surgery. On MV analysis, ECOG performance status and low serum albumin were independently associated with increased risk of 90 day mortality. Conclusions: Contemporary perioperative mortality and major complication rates for RCC patients with upper level thrombus are 10 and 34%, respectively. ECOG PS >1 and low serum albumin are associated with an increased risk of perioperative mortality, and should be considered when selecting patients for neoadjuvant systemic therapy trials.

scholarly journals Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
Lingjun Zhu ◽  
Miaomiao Chen ◽  
Xiaoping Lin
Keyword(s):  
Acute Coronary Syndrome ◽  
Serum Albumin ◽  
Mortality Risk ◽  
Serum Albumin Level ◽  
Meta Analysis ◽  
Albumin Level ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
The Impact ◽  
Low Serum

Abstract The prognostic utility of serum albumin level as a predictor of survival in patients with acute coronary syndrome (ACS) has attracted considerable attention. This meta-analysis sought to investigate the prognostic value of serum albumin level for predicting all-cause mortality in ACS patients. A systematic literature search was conducted in Pubmed and Embase databases until 5 March 2019. Epidemiological studies investigating the association between serum albumin level and all-cause mortality risk in ACS patients were included. Eight studies comprising 21667 ACS patients were included. Meta-analysis indicated that ACS patients with low serum albumin level had an increased risk of all-cause mortality (risk ratio [RR] 2.15; 95% confidence interval [CI] 1.68–2.75) after adjusting for important covariates. Subgroup analysis showed that the impact of low serum albumin level was stronger in hospital mortality (RR 3.09; 95% CI 1.70–5.61) than long-term all-cause mortality (RR 1.75; 95% CI 1.54–1.98). This meta-analysis demonstrates that low serum albumin level is a powerful predictor of all-cause mortality in ACS patients, even after adjusting usual confounding factors. However, there is lack of clinical trials to demonstrate that correcting serum albumin level by means of intravenous infusion reduces the excess risk of death in ACS patients.

scholarly journals Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients

Medicine ◽  
2016 ◽  
Vol 95 (26) ◽  
pp. e4050 ◽  
Author(s):  
Wen-Hung Huang ◽  
Ching-Wei Hsu ◽  
Cheng-Hao Weng ◽  
Tzung-Hai Yen ◽  
Jui-Hsiang Lin ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Serum Albumin ◽  
Carpal Tunnel ◽  
Serum Albumin Level ◽  
Hemodialysis Patients ◽  
Albumin Level ◽  
Catabolic Rate ◽  
Tunnel Syndrome ◽  
Protein Catabolic Rate ◽  
Low Serum

scholarly journals Lymphocyte Cell Ratios and Mortality among Incident Hemodialysis Patients

2017 ◽  
Vol 46 (5) ◽  
pp. 408-416 ◽  
Author(s):  
Christina Catabay ◽  
Yoshitsugu Obi ◽  
Elani Streja ◽  
Melissa Soohoo ◽  
Christina Park ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Cox Model ◽  
Characteristic Curve ◽  
Hemodialysis Patients ◽  
Mortality Prediction ◽  
Time Varying ◽  
Cox Models ◽  
Lymphocyte Ratio ◽  
Lymphocyte Cell

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been previously suggested as oncologic prognostication markers. These are associated with malnutrition and inflammation, and hence, may provide benefit in predicting mortality among hemodialysis patients. Methods: Among 108,548 incident hemodialysis patients in a large U.S. dialysis organization (2007–2011), we compared the mortality predictability of NLR and PLR with baseline and time-varying covariate Cox models using the receiver operating characteristic curve (AUROC), net reclassification index (NRI), and adjusted R2. Results: During the median follow-up period of 1.4 years, 28,618 patients died. Median (IQR) NLR and PLR at baseline were 3.64 (2.68–5.00) and 179 (136–248) respectively. NLR was associated with higher mortality, which appeared stronger in the time-varying versus baseline model. PLR exhibited a J-shaped association with mortality in both models. NLR provided better mortality prediction in addition to demographics, comorbidities, and serum albumin; ΔAUROC and NRI for 1-year mortality (95% CI) were 0.010 (0.009–0.012) and 6.4% (5.5–7.3%) respectively. Additionally, adjusted R2 (95% CI) for the Cox model increased from 0.269 (0.262–0.276) to 0.283 (0.276–0.290) in the non-time-varying model and from 0.467 (0.461–0.472) to 0.505 (0.500–0.512) in the time-varying model. There was little to no benefit of adding PLR to predict mortality. Conclusions: High NLR in incident hemodialysis patients predicted mortality, especially in the short-term period. NLR, but not PLR, added modest benefit in predicting mortality along with demographics, comorbidities, and serum albumin, and should be included in prognostication approaches.

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