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Serum Albumin Level and Risk for Mortality and Hospitalization in Adolescents on Hemodialysis

Sandra Amaral^*, Wenke Hwang, Barbara Fivush, Alicia Neu, Diane Frankenfield, and Susan Furth^,||

^* Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Wake Forest University School of Medicine, Winston-Salem, North Carolina; and Department of Pediatrics, Johns Hopkins Medical Institutions, Centers for Medicare and Medicaid Services, Office of Research, Development and Information and ^|| Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland

Correspondence: Dr. Sandra Amaral, Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Drive NE, Atlanta, GA 30322; Phone: 404-727-2450; Fax: 404-727-8213; E_mail: sandra_amaral{at}oz.ped.emory.edu

Background and objectives: National Kidney Foundation Dialysis Outcomes Quality Initiative practice guidelines recommend serum albumin 4.0 g/dl for adults who are on hemodialysis. There is no established pediatric target for albumin and little evidence to support use of adult guidelines. This study examined the association between albumin and risk for death and hospitalization in adolescents who are on hemodialysis.

Design, setting, participants, & measurements: This retrospective cohort study linked data on patients aged 12 to 18 yr in 1999 and 2000 from the Centers for Medicare and Medicaid Services’ End Stage Renal Disease Clinical Performance Measures Project with 4-yr hospitalization and mortality records in the United States Renal Data System. Albumin was categorized as <3.5/3.2, 3.5/3.2 and <4.0/3.7, and 4.0/3.7 g/dl.

Results: Of 675 adolescents, 557 were hospitalized and 50 died. Albumin 4.0/3.7 g/dl was associated with male gender, Hispanic ethnicity, and higher hemoglobin level. Those with albumin 4.0/3.7 g/dl had fewer deaths per 100 patient-years and fewer hospitalizations per time at risk. In multivariate analysis, patients with albumin 4.0/3.7 g/dl had 57% decreased risk for death. Poisson regression showed progressive decrease in hospitalization risk as albumin level increased; however, confidence intervals were similar between albumin 4.0/3.7 g/dl and albumin 3.5/3.2 and <4.0/3.7 g/dl.

Conclusions: This study demonstrates decreased mortality and hospitalization risk with albumin 3.5/3.2 g/dl and suggests that adolescent hemodialysis patients who are able to achieve serum albumin 4.0/3.7 g/dl may have the lowest mortality risk.