Abstract: TH-PO809

Pre- and Post-ESRD Trajectories of Serum Albumin among Incident ESRD Patients: A Transition of Care in CKD Study

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Lieu, Patricia W, UCLA, Los Angeles, California, United States
  • Soohoo, Melissa, UC Irvine, Orange, California, United States
  • Park, Christina, UC Irvine, Orange, California, United States
  • Rhee, Connie, UC Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, UC Irvine, Orange, California, United States
  • Streja, Elani, UC Irvine, Orange, California, United States
Background

Hypoalbuminemia is a strong predictor of mortality in chronic kidney disease patients, however the extent of change in serum albumin (Alb) in the year surrounding transition to end-stage renal disease (ESRD) is relatively unknown.

Methods

We examined serum Alb trajectories in the 1-year pre- and post-ESRD initiation among 31,053 patients who transitioned to ESRD from 2007-2014 using a mixed-effects regression model. Trajectories were stratified by baseline Alb levels in the 6-month pre-ESRD (prelude) period. Finally, we examined the association of 1-year pre-ESRD Alb slope with early mortality using Cox models adjusted for demographics and lab variables.

Results

The mean±SD age of the cohort was 68±11 years and included 2% females and 30% blacks. The median[IQR] of 1-year prelude Alb slope was -0.22[-0.48,0.23] g/dL/year. Among baseline Alb ≥2.8 g/dL, there was a sharp decline at initiation and a slow rise then plateau towards a normal range in the year after initiation. In patients with Alb <2.8 g/dL, there was a steep drop and a sudden increase in Alb in the few months surrounding transition. Moreover, a steep drop in pre-ESRD Alb of greater than -0.5 g/dL/year was associated with the highest risk of early 12-month post-ESRD mortality compared to no change in Alb slope [HR[95%CI]: 1.07[1.01, 1.13].

Conclusion

Across baseline albumin levels, pre-ESRD serum albumin tends to drop and then rise in the months around ESRD transition, while distinctions are observed for low baseline Alb. Also, a drop in Alb was associated with a higher risk of early mortality. Screening for rapid drops in Alb in the prelude period may identify those at greatest risk of early ESRD mortality. Further studies are required to determine if dietary and medication intervention to maintain elevated Alb impacts early ESRD outcomes.

Funding

  • NIDDK Support