SP233The Relationship Among Serum Kallistatin, Cardiovascular Markers and Mortality in Geriatric Patients with Acute Kidney Injury (original) (raw)
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Ischemia modified albumin levels and its association with clinical follow-up in acute renal failure
Journal of Turgut Ozal Medical Center
Aim: In cases with acute ischemia, albumin's binding capacity for transition metals decreases and the resulting albumin is defined as ischemia modified albumin (IMA). In this study, we aimed to investigate the relationship between IMA and clinical follow-up in patients with acute renal failure (ARF). Material and Methods: Levels of IMA were measured in 51(23 male, 28 female) patients with ARF. Venous blood samples were drawn from patients for biochemical tests and put in plain tubes containing the gel. Results: Mean age of male and female patients was 65.39±15.28 and 70.11±15.25, respectively. The IMA levels in 25.5% of the patients were within the normal range (<400 ABSU), while the IMA levels were higher (>400 ABSU) in 75.5% of the patients. The survival rates of patients in IMA <400 ABSU group for 12 and 24 months were 66.7% and for 30 and 32 months it was 33.3%; while the survival rates of patients in IMA ≥400 ABSU group for 12 months were 85.8%, for 24 months were 61.3%, and for 30 and 32 months were 30.6%. No significant difference was determined among survival rates of IMA groups (p=0.719). Conclusion: The comparison between the groups having normal or higher IMA values did not show any significant differences in terms of survival. However, in our study the proportion of patients who needed dialysis during treatment were significantly higher in higher IMA group(IMA≥400 ABSU). Therefore, we believe that higher IMA levels may indicate a necessity for dialysis in patients with ARF.
Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients
Jornal Brasileiro de Nefrologia, 2015
Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients Alterações precoces da albumina sérica: impacto sobre a mortalidade aos 2 anos em pacientes incidentes em hemodiálise Introduction/Objective: We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients. Methods: Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause. Results: 1,679 incident patients were included. They were 52 ± 15 years old, 58.7% male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923 patients had sAlb ≤ 38 g/L (Low sAlb Group) and 756 ones had sAlb > 38.0 g/L (Adequate sAlb Group). The mortality was significantly higher in Low sAlb Group (17% vs. 11%, p < 0.001). Early changes in sAlb significantly affected two-year mortality. Factoring the Kaplan Meier curve of Low sAlb Group by the presence of an increase in sAlb uncovered of a statistically significant difference in mortality favoring the ones whose sAlb went up (19% vs. 15%, p = 0.043). Differently, patients from Adequate sAlb Group with a decrease in their sAlb had a statistically higher mortality rate (13% vs. 8%, p = 0.029). Conclusions: Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb.
Early albumin level and mortality in hemodialysis patients: a retrospective study
Annals of Palliative Medicine, 2021
Background: Hypoalbuminemia is a significant risk factor of cardiovascular disease and all-cause death in patients undergoing conventional hemodialysis (HD). However, the albumin (ALB) level of these dialysis patients runs through the whole process of dialysis, and the prognostic value of serum ALB in the early stage of HD and the relationship between the early ALB value and death in HD patients has not been reported. Methods: The data of 447 patients with HD were retrospectively analyzed. The patients were stratified into three ALB (g/L) groups: low, ALB ≤34.2; moderate, 34.3< ALB <40.1; high, ALB ≥40.2. Survival trends of the three groups were analyzed by the Kaplan-Meier method. Results: Comparison of the clinical data among the three groups showed a positive correlation between Hb, RBC, K + , Ca 2+ , Mg 2+ , and PHOS (P<0.05), but a negative correlation between age and high-sensitivity C-reactive protein (hsCRP) (P<0.05). The ALB level in early HD patients was an independent predictor of death [hazard ratio (HR) =0.945; 95% confidence interval (CI): 0.916-0.976; P=0.000], while age and hsCRP were protective factors (HR =1.048, 95% CI: 1.028-1.067, P=0.000; HR =1.049, 95% CI: 1.024-1.075, P=0.000). The estimated median overall survival (OS) at early HD was 56.00 months in the low ALB group, 83.00 months in the moderate ABL group, and 95.00 months in the high ALB group. The Kaplan-Meier estimate of survival showed a significant difference in OS among the three groups (log-rank P=0.000). Conclusions: The early ALB level not only reflects the nutritional and chronic inflammation status of HD patients, but can also predict the prognosis, which has guiding significance for the management of HD patients.
Clinical and Experimental Emergency Medicine
Objective We aimed to investigate uric acid and albumin ratio (UA/A) as a marker of short-term mortality in acute kidney injury (AKI). Both uric acid and albumin are strongly correlated with the development and mortality of AKI. Methods The patients hospitalized from May 2019 to September 2019 for AKI were included in this study. The diagnostic odds ratio (DOR), Youden index (J), and the area under a receiver operating characteristic curve (AUROC) determined a cutoff UA/A ratio for mortality. Cox-regression analysis was performed to identify UA/A as a prognostic marker of the 30-day mortality rate. Results A total of 171 patients with an average age of 69.20 ± 13.0 (45.6% women) were included in the study. The average UA/A ratio was 3.3 ± 1.5 mg/g and 2.5 ± 1.0 mg/g in the nonsurvivor and survivor groups, respectively (P = 0.001). The best cutoff UA/A ratio associated with mortality was determined as 2.4 mg/g with a specificity of 52% and a sensitivity of 77% (DOR, 3.6; J, 28.8; AUROC, 0.644). Thirty-day cumulative survival rates of the low and high UA/A ratio groups were 85.9 ± 4.0% and 63.7 ± 5.0%, respectively. The estimated survival times of the low and high UA/A ratio groups were 27.7 days (95% confidence interval [CI], 26.2-29.3) and 23.9 days (95% Cl, 22.0-25.9), respectively. Conclusion We found a direct correlation between 30-day mortality and UA/A ratio at initial presentation in AKI patients regardless of age, comorbidities, and clinical and laboratory findings, including albuminuria.
Nutrition, 2020
Serum albumin (sAlb) may be a strong predictor of longevity in the general population and in chronic kidney disease. This study aimed to determine the relationship between sAlb concentrations and mortality risk independent of kidney function. Methods: This was a retrospective cohort study of 31 274 adults from the 1999À2010 National Health and Nutrition Examination Survey. The estimated glomerular filtration rate (eGFR) was examined as both a confounder and modifier of the association of sAlb with mortality risk. We examined the association of sAlb (categorized as <3.8, 3.8 to <4.0, 4.0 to <4.2, 4.2 to <4.4, 4.4 to <4.6, 4.6 to <4.8, and 4.8 g/dL) with mortality using Cox models. Subsequently, we conducted spline analyses to estimate the association of sAlb with allcause mortality across varying eGFR levels. Results: In unadjusted analyses, participants with incrementally lower sAlb concentrations of <4.6 g/dL had an increasingly higher mortality risk compared with those with sAlb levels ranging from 4.6 to <4.8 g/dL (reference), whereas those with higher sAlb levels of 4.8 g/dL had a lower mortality risk (hazard ratios [95% confidence interval]: 3.88 [3.26À4.62], 3.59 [3.01À4.27], 2.79 [2.37À3.29], 2.10 [1.79À2.48], 1.72 [1.45À2.03], and 0.71 [0.55À0.92] for sAlb concentrations of <3.8, 3.8 to <4.0, 4.0 to <4.2, 4.2 to <4.4, 4.4 to <4.6, and 4.8 g/dL, respectively). Adjusted analyses showed similar findings, although the association of higher sAlb levels of 4.8 g/dL with better survival was attenuated to the null. Spline analyses showed that participants with sAlb levels of <4.6 g/dL had higher mortality across all concentrations of eGFR, ranging from 30 to 120 mL/min/1.73 m 2 (reference: sAlb 4.6 g/dL). Conclusions: Among a nationally representative U.S. cohort, a graded association was observed between lower sAlb concentrations and higher death risk, which was robust across varying levels of kidney function.
Serum albumin is a strong predictor of death in chronic dialysis patients
Kidney International, 1993
Serum albumin is a strong predictor of death in chronic dialysis patients. We examined the predictive value of various clinical variables in assessing survival in chronic hemodialysis patients (N = 1,243, 524 females, 719 males) who were under treatment with hemodialysis as of January 1991 in Okinawa, Japan and who were followed up until April 1992. Basal clinical data such as sex, starting date of dialysis, primary renal disease, blood pressure, blood chemistry values, and dialysis prescription data obtained just prior to dialysis were registered at the start of the study. As of the end of April 1992, 104 had died, 16 were transplant recipients, and five had been transferred. Those who died had significantly lower levels of total protein, serum albumin, total cholesterol, triglyceride, BUN, serum creatinine, body weight, body height, diastolic blood pressure, and duration of hemodialysis than those who survived. Older patients and those with diabetes mellitus had a poorer prognosis. A forward stepwise logistic procedure by SAS was used to determine the predictive value of the above clinical variables.
Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure
Kidney International, 2003
Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure. Background. Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown. Methods. In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N ϭ 6), patients on peritoneal dialysis (N ϭ 7) and control subjects (N ϭ 8) using l-[1-13 C]-valine. Results. Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P Ͻ 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P Ͻ 0.01) as well as patients on peritoneal dialysis (P Ͻ 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 Ϯ 9 mg/kg/day versus 93 Ϯ 9 mg/kg/day, P Ͻ 0.05; ASR fibrinogen, 45 Ϯ 4 mg/kg/day versus 29 Ϯ 3 mg/kg/day, P Ͻ 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r 2 ϭ 0.665, P Ͻ 0.0001, N ϭ 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance. Conclusion. Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin
Review article: Biomarkers of clinical outcomes in advanced chronic kidney disease
Nephrology, 2009
Chronic kidney disease (CKD) is a complex condition, where the decrease in kidney function is accompanied by numerous metabolic changes affecting virtually all the organ systems of the human body. Many of the biomarkers characteristic of the individually affected organ systems have been associated with adverse outcomes including higher mortality in advanced CKD, whereas in persons without CKD these biomarkers may have no bearing on survival. It is believed that the high mortality seen in CKD is a result of several abnormalities conspiring to induce or aggravate a heightened degree of cardiovascular morbidity and predisposition to wasting syndrome. Not all the biomarkers may, however, be causally responsible for the adverse outcomes associated with them. We review various biomarkers of protein-energy wasting, inflammation, oxidative stress, potassium disarrays, acid-base disorders, bone and mineral disorders, glycemic status, and anemia. Although all of these biomarkers have shown associations with worsened outcomes in CKD, markers of protein-energy wasting, especially serum albumin, remain the strongest predictor of survival in CKD patients, especially those undergoing maintenance dialysis treatment. We also review the putative pathophysiologic mechanisms behind these associations, and present potential therapeutic interventions that could result in remedies to improve poor clinical outcomes in CKD, pending the results of current and future controlled trials.