Abstract: FR-PO1136
Association of Higher Albumin Levels with Better Outcomes in Patients with Pre-ESKD CKD: Findings from the KNOW-CKD Cohort
Session Information
- CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Lee, Hyunwoo, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Korea (the Republic of)
- Kim, Hyunsuk, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Korea (the Republic of)
- Jeong, Jong Cheol, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (the Republic of)
Background
While hypoalbuminemia is a recognized risk factor for mortality in end-stage kidney disease (ESKD), its prognostic significance in earlier stages of chronic kidney disease (CKD) remains less well established. This study investigated the association between serum albumin levels and renal outcomes in non-dialysis CKD patients with albumin ≥3.5 g/dL.
Methods
We analyzed 2,232 participants from the KNOW-CKD cohort, stratified into four groups: Q1 (<4.0), Q2 (4.0–4.19), Q3 (4.2–4.49), and Q4 (≥4.5 g/dL). Renal events were defined as a composite of a 50% eGFR decline, doubling of serum creatinine, or initiation of dialysis/transplantation. Kidney events included dialysis or transplantation. Multivariable Cox proportional hazards models and competing risk regression were applied. Role of inflammatory biomarkers (hsCRP, adiponectin, osteoprotegerin) were assessed using four-way mediation analysis.
Results
In continuous models, each 1 g/dL increase in albumin was associated with significantly lower risks of renal (adjusted HR 0.777, 95% CI 0.623–0.969) and kidney events (HR 0.727, 95% CI 0.567–0.933). In quartile-based models (reference: Q1), Q3 and Q4 showed lower HRs for kidney events (Q3: 0.832 [0.655–1.055]; Q4: 0.752 [0.559–1.011]), though statistical significance was marginal. Renal events did not show consistent trends across quartiles. Mediation analysis showed that the majority of the effect of albumin on ESRD was direct for hsCRP (CDE: 88.7%) and adiponectin (CDE: 94.7%), while osteoprotegerin exhibited prominent interaction effects (INTref: 68.8%, INTmed: 47.8%). Q4 was associated with the lowest all-cause mortality risk (HR 0.433, 95% CI 0.222–0.842).
Conclusion
Higher serum albumin levels, even within the normal range, were independently associated with better renal outcomes and survival, underscoring their potential role as both a prognostic marker and therapeutic target in pre-dialysis CKD.
Kaplan-Meier curve according to 4 albumin groups
Funding
- Government Support – Non-U.S.