Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis.
Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis.
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DOI：
10.1053/j.ajkd.2011.03.018
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发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Kalantar-Zadeh K
中科院分区：
文献类型：
--
作者：
Mehrotra R;Duong U;Jiwakanon S;Kovesdy CP;Moran J;Kopple JD;Kalantar-Zadeh K
血清白蛋白可预测透析患者的死亡率，并用于评估其健康状况和提供的护理质量。腹膜透析（PD）患者死亡风险增加的血清白蛋白阈值水平是否与血液透析（HD）患者相同尚未研究。对透析患者进行观察性队列研究，以确定PD患者血清白蛋白的生存预测性，并将其与HD患者进行比较。130，052名透析患者（PD，12，171名; HD，117，851名）在DaVita Inc.拥有的580个透析单位中的任何一个接受治疗。2001年7月1日至2006年6月30日，随后至2007年6月30日基线和时间平均血清白蛋白（通过溴甲酚绿色测定），以及6个月内血清白蛋白的变化-全因、心血管和感染相关死亡率。基线血清白蛋白< 3.0 g/dl的PD患者的全因和心血管死亡率的校正风险高出3倍以上，感染相关死亡率的风险高出3.4倍（参考组：血清白蛋白4.00-4.19 g/dl）。在6个月内血清白蛋白升高≥ 0.3 g/dl的PD患者中，校正的全因死亡率显著较低，而在血清白蛋白降低≥ 0.2 g/dl的患者中，校正的全因死亡率显著较高（参考组：血清白蛋白变化，+0.1至-0.1 g/dl）。血清白蛋白< 4.0 g/dl的HD患者死亡风险显著增加，而血清白蛋白< 3.8 g/dl的PD患者死亡风险显著增加。对于每个白蛋白类别，PD患者的总体死亡风险低于HD患者（参考组：血清白蛋白为4.00-4.19 g/dl的HD患者）。研究只能识别没有因果关系的关联，并且不能排除残留混杂。总之，血清白蛋白可预测PD和HD患者的全因、心血管和感染相关死亡率。然而，死亡风险增加的阈值因透析方式而异，制定质量标准的机构或组织应考虑这种差异。
Serum albumin predicts mortality in dialysis patients and is used to assess their health status and the quality of delivered care. Whether the threshold level of serum albumin at which mortality risk increases in peritoneal dialysis (PD) patients is the same as for hemodialysis (HD) patients has not been studied. Observational cohort study of dialysis patients undertaken to determine the survival-predictability of serum albumin in PD patients, and to compare it with that in HD patients. 130,052 dialysis patients (PD, 12,171; HD, 117,851) who received treatment in any of the 580 dialysis units owned by DaVita Inc. between 7/1/2001 through 6/30/2006, followed through 6/30/2007 Baseline and time-averaged serum albumin (assayed by bromcresol green), and change in serum albumin over six months All-cause, cardiovascular, and infection-related mortality. PD patients with baseline serum albumin < 3.0 g/dl had an over three-fold higher adjusted risk for all-cause and cardiovascular mortality, and 3.4-fold higher risk for infection-related mortality (reference group: serum albumin 4.00–4.19 g/dl). The adjusted all-cause mortality was significantly lower in PD patients with ≥ 0.3 g/dl increase in serum albumin over six months, and significantly higher in whom it decreased by ≥ 0.2 g/dl (reference group: serum albumin change, +0.1 to −0.1 g/dl). Significant increase in death risk was evident for HD patients with serum albumin < 4.0 g/dl but at < 3.8 g/dl for PD patients. For each albumin category, the overall death risk for PD patients was lower than of HD patients (reference group: HD patients with serum albumin, 4.00–4.19 g/dl). Study can only identify associations without attribution of causality and residual confounding cannot be excluded. To conclude, serum albumin predicts all-cause, cardiovascular, and infection-related mortality in both PD and HD patients. However, the threshold at which risk for death increases varies by dialysis modality and this difference should be considered by agencies or organizations that set quality standards.
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影响因子：
3.3
作者：
Chiu, Yi-Wen;Jiwakanon, Sirin;Lukowsky, Lilia;Duong, Uyen;Kalantar-Zadeh, Kamyar;Mehrotra, Rajnish
通讯作者：
Mehrotra, Rajnish
影响因子：
13.6
作者：
Paniagua, R;Amato, D;Mujais, S
通讯作者：
Mujais, S
影响因子：
13.6
作者：
Weinhandl, Eric D.;Foley, Robert N.;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
13.2
作者：
Wang, Q;Bernardini, J;Fried, L
通讯作者：
Fried, L
影响因子：
19.6
作者：
Kaysen, GA;Chertow, GM;Levin, NW
通讯作者：
Levin, NW