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. 2019 Feb 17:2019:7825804.
doi: 10.1155/2019/7825804. eCollection 2019.

The Level of Serum Albumin Is Associated with Renal Prognosis in Patients with Diabetic Nephropathy

Junlin Zhang  1 , Rui Zhang  1 , Yiting Wang  1 , Hanyu Li  1 , Qianqian Han  1 , Yucheng Wu  1 , Tingli Wang  1 , Fang Liu  1
Affiliations

The Level of Serum Albumin Is Associated with Renal Prognosis in Patients with Diabetic Nephropathy

Junlin Zhang et al. J Diabetes Res. .

Abstract

Objective: Although hypoalbuminemia is frequently found in most patients with diabetic nephropathy (DN), its relationship to the severity and progression of DN remains largely unknown. Our aim was to investigate the association between the serum albumin levels and clinicopathological features and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and biopsy-proven DN.

Materials and methods: A total of 188 patients with T2DM and biopsy-proven DN followed up for at least one year were enrolled. The patients were divided into four groups based on the albumin levels: normal group: ≥35 g/L (n = 87); mild group: 30-35 g/L (n = 34); moderate group: 25-30 g/L (n = 36); and severe group: <25 g/L (n = 31). The renal outcome was defined by progression to end-stage renal disease. The impact of the serum albumin level on renal survival was estimated using Cox regression analysis.

Results: Among the cases, the serum albumin level had a significant correlation with proteinuria, renal function, and glomerular lesions. A multivariate Cox regression analysis indicated that the severity of hypoalbuminemia remained significantly associated with an adverse renal outcome, independent of clinical and histopathological features. In reference to the normal group, the risk of progression to ESRD increased such that the hazard ratio (HR) for the mild group was 2.09 (95% CI, 0.67-6.56, p = 0.205), 6.20 (95% CI, 1.95-19.76, p = 0.002) for the moderate group, and 7.37 (95% CI, 1.24-43.83, p = 0.028) for the severe group.

Conclusions: These findings suggested that hypoalbuminemia was associated with a poorer renal prognosis in patients with T2DM and DN.

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Figures

Figure 1
Figure 1
Flowchart of study participants.
Figure 2
Figure 2
Kaplan–Meier curves of the renal survival rate in DN patients with different serum albumin levels. The 5-year renal survival rate was estimated to be 64.14%, 35.70%, 10.54%, and 0% for the normal (≥35 g/L), mild (30-35 g/L), moderate (25-30 g/L), and severe (<25 g/L) groups, respectively. Median survival time for ESRD after renal biopsy was 31 months, 24 months, and 16 months for the mild, moderate, and severe groups, respectively. There was a significant difference of the renal survival rate between any two groups (p < 0.05).
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