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Abstract: PO1076

The Impact of Serum Albumin Levels on Excess Hospital Spending

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Rosen, Melissa M., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
Background

National Kidney Foundation K/DOQI guidelines recommend that hemodialysis patients have serum albumin (sA) levels greater than or equal to 4 g/dL. Serum albumin lower than 4 g/dL has long been associated with an increased risk of morbidity and mortality in dialysis patients. Compared to both low and high flux dialyzers, a mean albumin loss of 3g per dialysis session has been observed with medium cut-off (MCO) dialyzers (Kim et al., BMC 2020; Kirsch et al. NDT, 2017) which may decrease sA levels and increase the risk of hypoalbuminemia (serum albumin ≤3.5 g/dL). The aim of this analysis was to estimate the impact of sA levels on hospitalization and associated cost.

Methods

Prior research conducted by Rocco et al. (J. Am. Soc. Nephrol., 1996) identified sA level as a risk factor for hospitalization in ESKD patients receiving dialysis and estimated hospital utilization associated with sA levels. Data from this analysis was used to show that relative to patients with sA ≥4 g/dL, on average each year, patients with sA of 3.5-3.99 g/dL, sA of 3.0-3.49 g/dL, and sA≤ 3.0 g/dL have 3.98, 7.65, and 7.8 more hospital days, respectively. Using an average cost per hospitalization for a dialysis patient of $15,907.18 and the average length of stay (11.3 days) from USRDS, and data from Rocco et al. (1996), we estimated the additional hospital spending associated with reduced serum albumin levels.

Results

Based on previous research demonstrating an association between sA levels < 4 g/dL and increased risk of hospitalization, we estimated the hospitalization costs associated with having reduced serum albumin. Relative to hemodialysis patients with ≥4 g/dL, we calculated that having a lower average sA level may result in excess healthcare spending of $5,602 for sA of 3.5-3.99 g/dL, $10,769 for sA of 3.0-3.49, and $10,980 for sA less than or equal to 3.0 g/dL.

Conclusion

Lower serum albumin levels are associated with increased hospital admissions, which is estimated to lead to excess hospital spending on average of $5,602-$10,980 per patient per year. Preventing albumin loss in dialysis patients may help to reduce the risk of hospitalization.

Funding

  • Commercial Support