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. 2017 Jan;27(1):26-36.
doi: 10.1053/j.jrn.2016.07.001. Epub 2016 Aug 12.

Concurrence of Serum Creatinine and Albumin With Lower Risk for Death in Twice-Weekly Hemodialysis Patients

Jialin Wang  1 , Elani Streja  2 , Melissa Soohoo  2 , Joline L T Chen  3 , Connie M Rhee  2 , Taehee Kim  4 , Miklos Z Molnar  5 , Csaba P Kovesdy  6 , Rajnish Mehrotra  7 , Kamyar Kalantar-Zadeh  8
Affiliations

Concurrence of Serum Creatinine and Albumin With Lower Risk for Death in Twice-Weekly Hemodialysis Patients

Jialin Wang et al. J Ren Nutr. 2017 Jan.

Abstract

Objective: Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking.

Design and subjects: We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (<6 vs. ≥6 mg/dL) and albumin (<3.5 g/dL vs. ≥3.5 g/dL) for each treatment frequency yielding a total of 8 groups.

Results: Patients were aged 70 ± 14 years and included 48% women and 55% diabetics. Using the thrice-weekly hemodialysis patients with creatinine ≥ 6 mg/dL and albumin ≥ 3.5 g/dL as reference, patients with creatinine <6 mg/dL and albumin <3.5 g/dL had a 1.8-fold higher risk of mortality (hazard ratio: 1.75, 95% confidence interval: 1.33-2.30) in twice-weekly and 2.2-fold increased risk of mortality (hazard ratio: 2.21, 95% confidence interval: 1.81-2.70) in thrice-weekly hemodialysis patients, respectively in fully adjusted models adjusted for demographics, comorbidities, and markers of malnutrition and inflammation. A test for interaction showed that there was no significant difference in albumin creatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (P-for-interaction = .7667).

Conclusions: Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients.

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Figures

Figure 1
Figure 1
Cohort Construction
Figure 2
Figure 2
Baseline survival hazard ratio over 5 years according to concurrence of serum creatinine (mg/dl) and albumin (g/dl) in total after matched hemodialysis patients (n=5,561).
Figure 3
Figure 3
Baseline survival hazard ratio over 5 years according to concurrence of serum creatinine (mg/dl) and albumin (g/dl) in after matched twice-weekly hemodialysis patients (n=1,113).
Figure 4
Figure 4
Baseline survival hazard ratio over 5 years according to concurrence of serum creatinine (mg/dl) and albumin (g/dl) in after matched thrice-weekly hemodialysis patients (n=4,448).
Figure 5
Figure 5
Baseline survival hazard ratio over 5 years according to concurrence of serum creatinine (mg/dl) and albumin (g/dl) among after matched twice-weekly (n=1,113) and thrice-weekly (n=4,448) hemodialysis patients.
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