TY - JOUR
T1 - Serum albumin and hospitalization among pediatric patients with end-stage renal disease who started dialysis therapy
AU - Okuda, Yusuke
AU - Obi, Yoshitsugu
AU - Streja, Elani
AU - Laster, Marciana
AU - Rhee, Connie
AU - Langman, Craig B.
AU - Jernigan, Stephanie M.
AU - Salusky, Isidro B.
AU - Tentori, Francesca
AU - Schreiber, Martin J.
AU - Brunelli, Steven M.
AU - Kalantar-Zadeh, Kamyar
N1 - Funding Information:
We thank Da Vita Clinical Research for providing statistically de-identified clinical data for this research.
Publisher Copyright:
© 2019, IPNA.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: Hypoalbuminemia is a strong predictor of hospitalization and mortality among adult dialysis patients. However, data are scant on the association between serum albumin and hospitalization among children new to dialysis. Methods: In a retrospective cohort study of children 1–17 years old with end-stage renal disease receiving dialysis therapy in a large US dialysis organization 2007–2011, we examined the association of serum albumin with hospitalization frequency and total hospitalization days using a negative binomial regression model. Results: Among 416 eligible patients, median (interquartile range) age was 14 (10–16) years and mean ± SD baseline serum albumin level was 3.7 ± 0.8 g/dL. Two hundred sixty-six patients (64%) were hospitalized during follow-up with an incidence rate of 2.2 (95%CI, 1.9–2.4) admissions per patient-year. There was a U-shaped association between serum albumin and hospitalization frequency; hospitalization rates (95%CI) were 2.7 (2.2–3.2), 1.9 (1.5–2.4), 1.6 (1.3–1.9), and 2.7 (1.7–3.6) per patient-year among patients with serum albumin levels < 3.5, 3.5– < 4.0, 4.0– < 4.5, and ≥ 4.5 g/dL, respectively. Case mix-adjusted hospitalization incidence rate ratios (IRRs) (95%CI) were 1.63 (1.24–2.13), 1.32 (1.10–1.58), and 1.25 (1.06–1.49) at serum albumin levels 3.0, 3.5, and 4.5 g/dL, respectively (reference: 4.0 g/dL). Similar trends were observed in hospitalization days. These associations remained robust against further adjustment for laboratory variables associated with malnutrition and inflammation. Conclusions: Both high and low serum albumin were associated with higher hospitalization in children starting dialysis. Because the observed association is novel and not fully explainable especially for high serum albumin levels, interpreting the results requires caution and further studies are needed to confirm and elucidate this association before clinical recommendations are made.
AB - Background: Hypoalbuminemia is a strong predictor of hospitalization and mortality among adult dialysis patients. However, data are scant on the association between serum albumin and hospitalization among children new to dialysis. Methods: In a retrospective cohort study of children 1–17 years old with end-stage renal disease receiving dialysis therapy in a large US dialysis organization 2007–2011, we examined the association of serum albumin with hospitalization frequency and total hospitalization days using a negative binomial regression model. Results: Among 416 eligible patients, median (interquartile range) age was 14 (10–16) years and mean ± SD baseline serum albumin level was 3.7 ± 0.8 g/dL. Two hundred sixty-six patients (64%) were hospitalized during follow-up with an incidence rate of 2.2 (95%CI, 1.9–2.4) admissions per patient-year. There was a U-shaped association between serum albumin and hospitalization frequency; hospitalization rates (95%CI) were 2.7 (2.2–3.2), 1.9 (1.5–2.4), 1.6 (1.3–1.9), and 2.7 (1.7–3.6) per patient-year among patients with serum albumin levels < 3.5, 3.5– < 4.0, 4.0– < 4.5, and ≥ 4.5 g/dL, respectively. Case mix-adjusted hospitalization incidence rate ratios (IRRs) (95%CI) were 1.63 (1.24–2.13), 1.32 (1.10–1.58), and 1.25 (1.06–1.49) at serum albumin levels 3.0, 3.5, and 4.5 g/dL, respectively (reference: 4.0 g/dL). Similar trends were observed in hospitalization days. These associations remained robust against further adjustment for laboratory variables associated with malnutrition and inflammation. Conclusions: Both high and low serum albumin were associated with higher hospitalization in children starting dialysis. Because the observed association is novel and not fully explainable especially for high serum albumin levels, interpreting the results requires caution and further studies are needed to confirm and elucidate this association before clinical recommendations are made.
KW - Hospitalization
KW - Hyperalbuminemia
KW - Hypoalbuminemia
KW - Incident dialysis patients
KW - Protein energy wasting
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U2 - 10.1007/s00467-019-04270-2
DO - 10.1007/s00467-019-04270-2
M3 - Article
C2 - 31218394
AN - SCOPUS:85067784055
VL - 34
SP - 1799
EP - 1809
JO - Pediatric Nephrology
JF - Pediatric Nephrology
SN - 0931-041X
IS - 10
ER -