Association of hypoalbuminemia with short-term and long-term mortality in patients undergoing continuous renal replacement therapy
Jong Joo Moon , Yaerim Kim , Dong Ki Kim , Kwon Wook Joo , Yon Su Kim , Seung Seok Han
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Correspondence to: Seung Seok Han
Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail: hansway80@gmail.com

Edited by Sejoong Kim, Seoul National University, Seoul, Republic of Korea
Received: August 20, 2019; Revised: October 21, 2019; Accepted: November 19, 2019; Published online: January 30, 2020.
© The Korean Society of Nephrology. All rights reserved.

Abstract
Background: Hypoalbuminemia reflects several pathological conditions, including nutritional deficiencies and chronic inflammation. However, its relationship with short-term and long-term mortality in patients undergoing continuous renal replacement therapy (CRRT) remains unclear. The present study aimed to assess the effect of hypoalbuminemia on mortality in a large cohort of patients undergoing CRRT.
Methods: The study retrospectively reviewed 1,581 patients who underwent CRRT for the treatment of acute kidney injury from 2010 to 2016. The patients were categorized by tertiles of serum albumin levels at CRRT initiation. The odds ratios and hazard ratios for the risk of all-cause mortality were calculated before and after adjustment for multiple covariates.
Results: The mean albumin level was 2.7 ± 0.6 g/dL at CRRT initiation. During a median follow-up period of 14 days (maximum, 4 years), 1,040 patients (65.8%) died. The risk of overall mortality was higher in the first tertile group than in the third tertile group (hazard ratio, 1.9 [1.63-2.21]). When the mortality rate was stratified by timeframe, the risk was steadily higher in the first tertile group than in the third tertile group (odds ratios: 3.0 [2.34-3.87] for 2-week mortality, 2.7 [2.12-3.52] for 1-month mortality, 2.7 [2.08-3.53] for 6-month mortality, and 2.8 [2.11-3.62] for 1-year mortality). Additionally, the rates of intensive care unit mortality and in-hospital mortality were higher in the first tertile group than in the third tertile group.
Conclusion: The initial hypoalbuminemia was independently associated with short-term and long-term mortality in patients undergoing CRRT. Thus, the serum albumin level should be monitored during CRRT.
Keywords: Acute kidney injury, Continuous renal replacement therapy, Hypoalbuminemia, Mortality


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