HYPOALBUMINEMIA, CARDIAC MORBIDITY, AND MORTALITY IN END-STAGE RENAL-DISEASE

A cohort of 432 ESRD (261 hemodialysis and 171 peritoneal dialysis) pa tients was followed up prospectively for an average of 41 months. Base line and annual demographic, clinical, and echocardiographic assessmen ts were performed, as well as serial clinical and laboratory tests mea sured monthly while patients were on dialysis therapy, Among hemodialy sis patients, after adjustment was made for age, diabetes, and ischemi c heart disease, as well as hemoglobin and blood pressure levels measu red serially, a 10-g/L fail in mean serum albumin level was independen tly associated with the the development of de nova (relative risk (RR) , 2.22; P = 0.001) and recurrent cardiac failure (RR, 3.84; P = 0.003) , de nova (RR, 5.29; P = 0.001) and recurrent ischemic heart disease ( RR, 4.24; P = 0.005), cardiac mortality (RR, 5.60; P = 0.001), and ove rall mortality (RR, 4.33; P < 0.001), Among peritoneal dialysis patien ts, a 10-g/L fall in mean serum albumin level was independently associ ated with the progression of left ventricular dilation as seen on foll ow-up echocardiography (beta, 13.4 mL/m(2); P = 0.014), the developmen t of de nova cardiac failure (RR, 4.16; P = 0.003), and overall mortal ity (RR, 2.06; P < 0.001). Hypoalbuminemia, a major adverse prognostic factor in dialysis patients, is strongly associated with cardiac dise ase.