Cross-sectional and longitudinal predictors of serum albumin in hemodialysis patients

Background. Lower serum albumin concentrations predict increased mortality in hemodialysis (HD) patients. Many demographic, comorbidity, and modifiabl e treatment-related factors that predict HD patient outcomes may be associa ted with serum albumin. Methods. Cross-sectional predictors of baseline albumin on December 31, 199 3 were sought (N = 3981). Additional effects of the same baseline predictor s on subsequent trends in albumin over one year were examined in a nested s ubsample of patients (N = 2245). Wave-1 of the United States Renal Data Sys tem Dialysis Morbidity and Mortality special study provided the data. Results. Significant associations (P < 0.05) are summarized as older age, f emale gender, peripheral vascular disease, chronic obstructive pulmonary di sease, and cancer predicted a lower baseline albumin and negatively influen ced subsequent albumin trends. Baseline albumin was higher for blacks (vs. whites), lower for smoking and diabetes, and lower during the first year of HD treatment (<3 months and 3 to 12 months, vs. >1 year). Trend analysis s howed more positive albumin slopes for patients in their first year on HD a nd more negative slopes for Native Americans (vs. whites). Baseline albumin was correlated with the type of vascular access being used [arteriovenous (AV) fistulas > AV grafts > permanent catheters > temporary catheters]. Tre nd analysis predicted more negative albumin slopes for AV grafts and perman ent catheters (vs. AV fistula access). Baseline albumin correlated inversel y with bicarbonate and directly with hematocrit. Dialysis with unmodified c ellulose membranes, without reuse, predicted lower baseline albumin than th e other membrane-reuse categories. Conclusions. Several exposures, which may be modifiable, were associated wi th serum albumin.