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Kidney Week

Abstract: FR-PO293

Serum Albumin and All-Cause Mortality Across Varying Levels of Kidney Function

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Tortorici, Amanda R., UC Irvine Medical Center, Irvine, California, United States
  • Naderi, Neda, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  • Tang, Ying, Shengjing Hospital of China Medical University, Shenyang, China
  • Park, Christina, UC Irvine Medical Center, Irvine, California, United States
  • You, Amy Seung, UC Irvine Medical Center, Irvine, California, United States
  • Norris, Keith C., UCLA, Marina Del Rey, California, United States
  • Obi, Yoshitsugu, UC Irvine Medical Center, Irvine, California, United States
  • Streja, Elani, UC Irvine Medical Center, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States

Serum albumin (sAlb) may be a strong predictor of longevity in the general population and in chronic kidney disease populations. Our objective was to determine the relationship between sAlb concentrations and mortality risk independent of kidney function.


We analyzed a retrospective cohort of 31,274 adults from the 1999-2010 National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was examined as both a confounder and modifier of the association of sAlb with mortality risk. We examined the association of sAlb categorized in 7 strata with mortality using Cox models. Covariates in the adjusted model included age, sex, race/ethnicity, level of education, diabetes, smoking status, systolic blood pressure, serum total cholesterol level, and eGFR. We then conducted spline analyses to estimate the association of sAlb with all-cause mortality across varying eGFR levels.


In unadjusted analyses, participants with incrementally lower sAlb concentrations <4.6g/dL had increasingly higher mortality risk compared to those with sAlb ranging 4.6-<4.8g/dL (reference), whereas those with higher sAlb ≥4.8g/dL had lower mortality risk: HRs (95%CI) 3.88 (3.26, 4.62), 3.59 (3.01, 4.27), 2.79 (2.37, 3.29), 2.10 (1.79, 2.48), 1.72 (1.45, 2.03), and 0.71 (0.55, 0.92) for sAlb concentrations of <3.8, 3.8-<4.0, 4.0-<4.2, 4.2-<4.4, 4.4-<4.6, and ≥4.8g/dL, respectively. Case-mix + eGFR adjusted analyses showed similar findings, although the association of higher sAlb ≥4.8g/dL with greater survival was attenuated to the null. Spline analyses showed participants with sAlb <4.6g/dL had higher mortality across all levels of eGFR ranging from 30 to 120 ml/min/1.73m2 (reference: sAlb ≥4.6g/dL) [Figure].


Among a representative US cohort, there was a graded association between lower sAlb concentrations with higher death risk, which was robust across varying levels of kidney function.


  • NIDDK Support