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. 2023 Dec;45(1):2176165.
doi: 10.1080/0886022X.2023.2176165.

Comparison of mortality according to baseline, first year, and mean albumin levels in peritoneal dialysis: a retrospective study

Erdem Çankaya  1 , Murat Altunok  1
Affiliations

Comparison of mortality according to baseline, first year, and mean albumin levels in peritoneal dialysis: a retrospective study

Erdem Çankaya et al. Ren Fail. 2023 Dec.

Abstract

Background: The relationship between hypoalbuminemia in peritoneal dialysis (PD) and mortality, risk of peritonitis, and decreased residual renal function (RRF) is known. However, we have not encountered a comprehensive study on which of the mean albumin values, at the beginning of peritoneal dialysis, in the first year, and during the peritoneal dialysis period, provide more predictive predictions regarding mortality, peritonitis risk, and RRF reduction.

Methods: A total of 407 PD patients in whom PD was initiated and followed up and PD was terminated were included in the study. Albumin levels, peritonitis, and RRF at the beginning of PD and at 3-month periods during PD were recorded.

Results: In the evaluation of the patients, there was a significant relationship between mean, first-year albumin values in RRF loss (p = 0.001, p = 0.006, respectively) and peritonitis (p < 0.001), but no significant correlation was found with baseline albumin values (p = 0.213, p = 0.137, respectively). In the comparison of mortality ROC analysis of PD patients, a significant correlation was found with mortality at baseline, first year, and mean albumin values (p < 0.001). However, in the multivariate Cox regression analysis, it was determined that there was a more significant relationship between first-year albumin and mean albumin values compared to baseline albumin values (HR 0.918 [95% CI 0.302-0.528] (p < 0.001)), (HR 1.161 [95% CI 0.229-0.429] (p < 0.001)), (HR 0.081 [95% CI 0.718-1.184] (p = 0.525)).

Conclusions: In conclusion, mean and first-year mean albumin levels provide more determinative predictions for mortality, risk of peritonitis, and maintenance of residual renal functions in peritoneal dialysis patients compared to baseline albumin.

Keywords: Peritoneal dialysis; albumin level; mortality; peritonitis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow chart of patients in the study group.
Figure 2.
Figure 2.
Kaplan–Meier log-rank analysis of RRF loss by albumin values and groups. (A) Analysis of RRF loss relative to the 3.5 g/dl level of mean albumin. (B) Analysis of RRF loss relative to 3.5 g/dl of baseline albumin. (C) Analysis of RRF loss relative to the 1st year mean albumin level of 3.5 g/dl. (D) Analysis of RRF loss by group-1, group-2, group-3, and group-4. p < 0.05 was considered statistically significant.
Figure 3.
Figure 3.
Kaplan–Meier analysis of first peritonitis episode risk by albumin values and groups. (A) Analysis of first peritonitis episode risk relative to the mean albumin level of 3.5 g/dl. (B) Analysis of first peritonitis episode risk relative to 3.5 g/dl of baseline albumin. (C) Analysis of first peritonitis episode risk based on the 1st year mean albumin level of 3.5 g/dl. (D) Analysis of first peritonitis episode risk according to group-1, group-2, group-3, and group-4. p < 0.05 was considered statistically significant.
Figure 4.
Figure 4.
Kaplan–Meier analysis of mortality by albumin values and groups. (A) Mortality analysis based on the 3.5 g/dl level of the mean albumin. (B) Mortality analysis based on 3.5 g/dl of baseline albumin. (C) Mortality analysis based on the 1st year mean albumin level of 3.5 g/dl. (D) Mortality analysis by group-1, group-2, group-3, and group-4. (E) ROC analysis graph showing mortality estimation by baseline, mean, and 1st year mean albumin values. p < 0.05 was considered statistically significant.
Figure 5.
Figure 5.
Pearson correlation plot of first year mean albumin and mean albumin values. There was a positive correlation between 1st year mean albumin values and mean albumin values (Pearson = 0.944, p < 0.001).
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