Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients

Background Although serum prealbumin is considered a valid indicator of nut ritional status in hemodialysis patients, there is relatively little eviden ce that its determination is of major prognostic significance. In this stud y, we aimed to determine the independent association of serum prealbumin wi th survival in hemodialysis patients, after adjusting for serum albumin and other indicators of protein energy nutritional status. Methods. Serum prealbumin was measured in more than 1600 maintenance hemodi alysis patients. We determined the correlations among prealbumin and other indicators of nutritional status, including serum albumin, and bioimpedance -derived indicators of body composition. The relationship between serum pre albumin and survival was determined using proportional hazards regression. Results. The serum albumin was directly correlated with the serum prealbumi n (r = 0.47, P < 0.0001), but still explained <25% of the variability in pr ealbumin. Prealbumin was inversely related to mortality, with a relative ri sk reduction of 6% per 1 mg/dL increase in prealbumin, even after adjusting for case mix, serum albumin, and other nutritional indicators. The increas e in risk with lower serum prealbumin concentrations was observed whether t he serum albumin was high or low. Conclusion. In hemodialysis patients, the serum prealbumin provides prognos tic value independent of the serum albumin and other established predictors of mortality in this population.