Top

BMC Nephrology

Published in:

Open Access 01-12-2023 | Chronic Kidney Disease | Research

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

Authors: Tong Cheng, Xiaoyu Wang, Yong Han, Jianbing Hao, Haofei Hu, Lirong Hao

Published in: BMC Nephrology | Issue 1/2023

Abstract

Objective

The study’s purpose is to explore the link of serum albumin on renal progression in patients with chronic kidney disease (CKD).

Methods

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.

Results

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 m². The annual decline in eGFR was 2.65 mL/min/1.73 m²/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.

Conclusion

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.

Available only for authorised users

Liu ZH. Nephrology in China. Nat Rev Nephrol. 2013;9(9):523–8.PubMedCrossRef

Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, et al. US renal data system 2010 annual data report. Am J Kidney Dis. 2011;57(1 Suppl 1):A8, e1-526.PubMedCrossRef

Foley RN, Murray AM, Li S, Herzog CA, McBean AM, Eggers PW, Collins AJ. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16(2):489–95.PubMedCrossRef

Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, Kleefstra N, Naimark D, Roderick P, Tonelli M, et al. Age and association of kidney measures with mortality and end-stage renal disease. JAMA. 2012;308(22):2349–60.PubMedPubMedCentralCrossRef

GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb 29;395(10225):709–33. https://doi.org/10.1016/S0140-6736(20)30045-3. Epub 2020 Feb 13.

Imai E, Horio M, Watanabe T, Iseki K, Yamagata K, Hara S, Ura N, Kiyohara Y, Moriyama T, Ando Y, et al. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol. 2009;13(6):621–30.PubMedCrossRef

Shlipak MG, Katz R, Kestenbaum B, Siscovick D, Fried L, Newman A, Rifkin D, Sarnak MJ. Rapid decline of kidney function increases cardiovascular risk in the elderly. J Am Soc Nephrol. 2009;20(12):2625–30.PubMedPubMedCentralCrossRef

Khan NA, Ma I, Thompson CR, Humphries K, Salem DN, Sarnak MJ, Levin A. Kidney function and mortality among patients with left ventricular systolic dysfunction. J Am Soc Nephrol. 2006;17(1):244–53.PubMedCrossRef

Coresh J, Turin TC, Matsushita K, Sang Y, Ballew SH, Appel LJ, Arima H, Chadban SJ, Cirillo M, Djurdjev O, et al. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA. 2014;311(24):2518–31.PubMedPubMedCentralCrossRef

10.

Kovesdy CP, Coresh J, Ballew SH, Woodward M, Levin A, Naimark DM, Nally J, Rothenbacher D, Stengel B, Iseki K, et al. Past decline versus current eGFR and subsequent ESRD risk. J Am Soc Nephrol. 2016;27(8):2447–55.PubMedCrossRef

11.

Lang J, Scherzer R, Weekley CC, Tien PC, Grunfeld C, Shlipak MG. Serum albumin and short-term risk for mortality and cardiovascular disease among HIV-infected veterans. AIDS (London, England). 2013;27(8):1339–43.PubMedCrossRef

12.

Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50(6):693–703.PubMedCrossRef

13.

Feldman JG, Gange SJ, Bacchetti P, Cohen M, Young M, Squires KE, Williams C, Goldwasser P, Anastos K. Serum albumin is a powerful predictor of survival among HIV-1-infected women. J Acquir Immune Defic Syndr (1999). 2003;33(1):66–73.CrossRef

14.

Lang J, Katz R, Ix JH, Gutierrez OM, Peralta CA, Parikh CR, Satterfield S, Petrovic S, Devarajan P, Bennett M, et al. Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders. Nephrol Dial Transplant. 2018;33(6):986–92.PubMedCrossRef

15.

Majoni SW, Barzi F, Hoy W, MacIsaac RJ, Cass A, Maple-Brown L, Hughes JT. Baseline liver function tests and full blood count indices and their association with progression of chronic kidney disease and renal outcomes in Aboriginal and Torres Strait Islander people: the eGFR follow- up study. BMC Nephrol. 2020;21(1):523.PubMedPubMedCentralCrossRef

16.

Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30.PubMedCrossRef

17.

Iimori S, Naito S, Noda Y, Sato H, Nomura N, Sohara E, Okado T, Sasaki S, Uchida S, Rai T. Prognosis of chronic kidney disease with normal-range proteinuria: the CKD-ROUTE study. PLoS One. 2018;13(1):e0190493.PubMedPubMedCentralCrossRef

18.

Iimori S, Naito S, Noda Y, Nishida H, Kihira H, Yui N, Okado T, Sasaki S, Uchida S, Rai T. Anaemia management and mortality risk in newly visiting patients with chronic kidney disease in Japan: the CKD-ROUTE study. Nephrology (Carlton). 2015;20(9):601–8.PubMedCrossRef

19.

Iimori S, Noda Y, Okado T, Naito S, Toda T, Chida Y, Kuwahara M, Ando R, Nishio Y, Maeda Y, et al. Baseline characteristics and prevalence of cardiovascular disease in newly visiting or referred chronic kidney disease patients to nephrology centers in Japan: a prospective cohort study. BMC Nephrol. 2013;14:152.PubMedPubMedCentralCrossRef

20.

Chiu YL, Chien KL, Lin SL, Chen YM, Tsai TJ, Wu KD. Outcomes of stage 3–5 chronic kidney disease before end-stage renal disease at a single center in Taiwan. Nephron Clin Pract. 2008;109(3):c109-118.PubMedCrossRef

21.

Kikuchi H, Kanda E, Mandai S, Akazawa M, Iimori S, Oi K, Naito S, Noda Y, Toda T, Tamura T, et al. Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study. Clin Exp Nephrol. 2017;21(1):55–62.PubMedCrossRef

22.

Muiesan ML, Ambrosioni E, Costa FV, Leonetti G, Pessina AC, Salvetti M, Trimarco B, Volpe M, Pontremoli R, Deferrari G, et al. Sex differences in hypertension-related renal and cardiovascular diseases in Italy: the I-DEMAND study. J Hypertens. 2012;30(12):2378–86.PubMedCrossRef

23.

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.PubMedCrossRef

24.

Satirapoj B, Tasanavipas P, Supasyndh O. Clinicopathological correlation in asian patients with biopsy-proven lupus nephritis. Int J Nephrol. 2015;2015:857316.PubMedPubMedCentralCrossRef

25.

Groenwold RH, White IR, Donders AR, Carpenter JR, Altman DG, Moons KG. Missing covariate data in clinical research: when and when not to use the missing-indicator method for analysis. CMAJ. 2012;184(11):1265–9.PubMedPubMedCentralCrossRef

26.

White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30(4):377–99.PubMedCrossRef

27.

Robson ME, Tung N, Conte P, Im SA, Senkus E, Xu B, Masuda N, Delaloge S, Li W, Armstrong A, et al. OlympiAD final overall survival and tolerability results: Olaparib versus chemotherapy treatment of physician’s choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer. Ann Oncol. 2019;30(4):558–66.PubMedPubMedCentralCrossRef

28.

Sutradhar R, Austin PC. Relative rates not relative risks: addressing a widespread misinterpretation of hazard ratios. Ann Epidemiol. 2018;28(1):54–7.PubMedCrossRef

29.

Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W163-194.PubMedCrossRef

30.

Pundole XN, Barbo AG, Lin H, Champlin RE, Lu H. Increased incidence of fractures in recipients of hematopoietic stem-cell transplantation. J Clin Oncol. 2015;33(12):1364–70.PubMedPubMedCentralCrossRef

31.

Noordzij M, Leffondré K, van Stralen KJ, Zoccali C, Dekker FW, Jager KJ. When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant. 2013;28(11):2670–7.PubMedCrossRef

32.

Rothenbacher D, Rehm M, Iacoviello L, Costanzo S, Tunstall-Pedoe H, Belch JJF, Söderberg S, Hultdin J, Salomaa V, Jousilahti P, et al. Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project. BMC Med. 2020;18(1):300.PubMedPubMedCentralCrossRef

33.

Hu H, Bi C, Lin T, Liu L, Song Y, Wang B, Wang P, Zhou Z, Fang C, Ma H, et al. Sex difference in the association between plasma selenium and first stroke: a community-based nested case-control study. Biol Sex Differ. 2021;12(1):39.PubMedPubMedCentralCrossRef

34.

Huang YQ, Liu L, Lo K, Huang JY, Zhang B, Feng YQ. The relationship between mean telomere length and blood pressure: results from the National Health and Nutrition Examination Surveys. Ann Transl Med. 2020;8(8):535.PubMedPubMedCentralCrossRef

35.

Zhang L, Xiong W, Peng Y, Zhang W, Han R. The effect of an intraoperative, lung-protective ventilation strategy in neurosurgical patients undergoing craniotomy: study protocol for a randomized controlled trial. Trials. 2018;19(1):85.PubMedPubMedCentralCrossRef

36.

Mullee A, Romaguera D, Pearson-Stuttard J, Viallon V, Stepien M, Freisling H, Fagherazzi G, Mancini FR, Boutron-Ruault MC, Kühn T, et al. Association between soft drink consumption and mortality in 10 European countries. JAMA Intern Med. 2019;179(11):1479–90.PubMedCrossRef

37.

Keidel D, Anto JM, Basagaña X, Bono R, Burte E, Carsin AE, Forsberg B, Fuertes E, Galobardes B, Heinrich J, et al. The role of socioeconomic status in the association of lung function and air pollution-a pooled analysis of three adult ESCAPE cohorts. Int J Environ Res Public Health. 2019;16(11):1901.PubMedPubMedCentralCrossRef

38.

Kanwar YS, Wada J, Sun L, Xie P, Wallner EI, Chen S, Chugh S, Danesh FR. Diabetic nephropathy: mechanisms of renal disease progression. Exp Biol Med (Maywood). 2008;233(1):4–11.PubMedCrossRef

39.

Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26(1):8–15.PubMedCrossRef

40.

Zhu F, Chen C, Zhang Y, Chen S, Huang X, Li J, Wang Y, Liu X, Deng G, Gao J. Elevated blood mercury level has a non-linear association with infertility in U.S. women: data from the NHANES 2013–2016. Reprod Toxicol (Elmsford, NY). 2020;91:53–8.CrossRef

41.

Haneuse S, VanderWeele TJ, Arterburn D. Using the E-value to assess the potential effect of unmeasured confounding in observational studies. JAMA. 2019;321(6):602–3.PubMedCrossRef

42.

Song H, Wei C, Hu H, Wan Q. Association of the serum albumin level with prognosis in chronic kidney disease patients. Int Urol Nephrol. 2022;54(9):2421–31.PubMedCrossRef

43.

Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int. 2011;80(1):93–104.PubMedPubMedCentralCrossRef

44.

Orlandi PF, Fujii N, Roy J, Chen HY, Lee Hamm L, Sondheimer JH, He J, Fischer MJ, Rincon-Choles H, Krishnan G, et al. Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. BMC Nephrol. 2018;19(1):150.PubMedPubMedCentralCrossRef

45.

Song HY, Wei CM, Zhou WX, Hu HF, Wan QJ. Association between admission hemoglobin level and prognosis in patients with type 2 diabetes mellitus. World J Diabetes. 2021;12(11):1917–27.PubMedPubMedCentralCrossRef

46.

Kadono M, Hasegawa G, Shigeta M, Nakazawa A, Ueda M, Yamazaki M, Fukui M, Nakamura N. Serum albumin levels predict vascular dysfunction with paradoxical pathogenesis in healthy individuals. Atherosclerosis. 2010;209(1):266–70.PubMedCrossRef

47.

Keller C, Katz R, Sarnak MJ, Fried LF, Kestenbaum B, Cushman M, Shlipak MG. Inflammatory biomarkers and decline in kidney function in the elderly: the Cardiovascular Health Study. Nephrol Dial Transplant. 2010;25(1):119–24.PubMedCrossRef

48.

Chen HC, Lin HJ, Huang CC, Chang CT, Chou CY. Maximum glomerular filtration decline rate is associated with mortality and poor renal outcome in chronic kidney disease patients. Blood Purif. 2019;48(2):131–7.PubMedCrossRef

49.

Descamps-Latscha B, Witko-Sarsat V, Nguyen-Khoa T, Nguyen AT, Gausson V, Mothu N, Cardoso C, Noël LH, Guérin AP, London GM, et al. Early prediction of IgA nephropathy progression: proteinuria and AOPP are strong prognostic markers. Kidney Int. 2004;66(4):1606–12.PubMedCrossRef

50.

Rutten FH, Gallagher J. What the general practitioner needs to know about their chronic heart failure patient. Card Fail Rev. 2016;2(2):79–84.PubMedPubMedCentral

51.

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.PubMedCrossRef

52.

Pavkov ME, Bennett PH, Knowler WC, Krakoff J, Sievers ML, Nelson RG. Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA. 2006;296(4):421–6.PubMedCrossRef

Title: The level of serum albumin is associated with renal prognosis and renal function decline in patients with chronic kidney disease
Authors: Tong Cheng
Xiaoyu Wang
Yong Han
Jianbing Hao
Haofei Hu
Lirong Hao
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Chronic Kidney Disease
Published in: BMC Nephrology / Issue 1/2023
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-023-03110-8

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Beneficial effects of time and energy restriction diets on the development of experimental acute kidney injury in Rat: Bax/Bcl-2 and histopathological evaluation

Proliferative glomerulonephritis with monoclonal IgG deposits: a unique case with a clinical course of over 46 years

A survival case of visceral disseminated varicella zoster virus infection in a patient with systemic lupus erythematosus

Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults

Effect of high density lipoprotein cholesterol (HDL-C) on renal outcome in patients with nephrotic syndrome complicated with steroid-induced diabetes mellitus(SIDM)

Development and nationwide validation of kidney graft injury markers using urinary exosomes and microvesicles (complete English translation of the Japanese version)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials