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. 2017 Jul 19;12(7):e0180750.
doi: 10.1371/journal.pone.0180750. eCollection 2017.

Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study

Mi-Yeon Yu  1 , Sung Woo Lee  2 , Seon Ha Baek  3 , Ki Young Na  4 , Dong-Wan Chae  4 , Ho Jun Chin  4 , Sejoong Kim  4
Affiliations

Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study

Mi-Yeon Yu et al. PLoS One. .

Abstract

Background: Development of acute kidney injury (AKI) is common and is associated with poor outcomes. We aimed to determine whether hypoalbuminemia (HA) at admission could be a risk factor for the development of AKI and mortality in hospitalized patients.

Methods: We enrolled patients who were admitted to Seoul National University Bundang Hospital from January 2013 to December 2013. HA at admission was defined as a serum albumin level < 3.4 mg/dL measured within two days after admission. AKI was defined as an increase in the serum creatinine level by ≥0.3 mg/dL or ≥1.5 times of the baseline value during the hospital stay.

Results: A total of 19,472 patients were enrolled and divided into HA and normoalbuminemia (NA) groups at admission. The incidence of AKI was 10.7% (340/3179) in the HA group and 4.1% (662/16293) in the NA group (adjusted odds ratio [OR], 1.243; 95% confidence interval [CI], 1.069-1.445; P = 0.005). The hazard ratios for the 30-day, 90-day, and 1-year mortality were 1.873 (95% CI, 1.383-2.537; P < 0.001), 1.710 (95% CI, 1.410-2.072; P < 0.001), and 1.372 (95% CI, 1.214-1.551; P < 0.001), compared to the NA group. In patients with AKI, albumin replacement improved renal recovery (OR, 2.605; 95% CI, 1.450-4.681; P = 0.001). The mortality rate was not different according to albumin replacement.

Conclusions: HA is associated with the development of AKI and high mortality in hospitalized patients. Replacement of albumin after the development of AKI may contribute to renal recovery. Further clinical trials are warranted.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection algorithm.
Fig 2
Fig 2. Clinical outcomes according to the serum albumin groups.
*P < 0.001. †The statistical analysis was performed in only 1,002 patients with AKI. AKI, acute kidney injury.
Fig 3
Fig 3. Forest plot of the odds ratio for AKI development in the multivariate logistic regression model.
The odds ratio is adjusted for all covariables in Table 1. *P-interaction < 0.05, **P-interaction < 0.01, and ***P-interaction < 0.001. AKI, acute kidney injury; CVD, cardiovascular disease; HA, hypoalbuminemia. Error bars indicate 95% confidence intervals.
Fig 4
Fig 4. Cumulative survival rate according to the serum albumin and acute kidney injury groups.
A, B, and C show the survival curves of the serum albumin, AKI, and combined albumin and AKI groups for the mortalities, respectively. *P < 0.001 vs. patients with NA without AKI; †P < 0.001 vs. patients with HA without AKI; ‡P < 0.01 vs. patients with NA and AKI using the log-rank test. AKI; acute kidney injury, HA; hypoalbuminemia, NA; normoalbuminemia.
See this image and copyright information in PMC

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