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Serum albumin and hospitalization among pediatric patients with end-stage renal disease who started dialysis therapy

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Abstract

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.

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Acknowledgements

We thank Da Vita Clinical Research for providing statistically de-identified clinical data for this research.

Funding

The authors are supported by the research grants from the NIH/NIDDK including T32-DK104687 (M.L.), K23-DK102903 (C.M.R), R03-DK114642 (C.M.R), K24-DK091419 (K.K.-Z), U01-DK102163 (K.K.-Z), and philanthropist grants from H. Simmons, L. Chang and J. Lee.

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Authors and Affiliations

  1. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, Orange, CA, 92868, USA

    Yusuke Okuda, Yoshitsugu Obi, Elani Streja, Connie Rhee & Kamyar Kalantar-Zadeh

  2. University of California Los Angeles, Los Angeles, CA, USA

    Marciana Laster & Isidro B. Salusky

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Craig B. Langman

  4. Emory University School of Medicine, Atlanta, GA, USA

    Stephanie M. Jernigan

  5. DaVita Clinical Research, Minneapolis, MN, USA

    Francesca Tentori, Martin J. Schreiber & Steven M. Brunelli

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  1. Yusuke Okuda
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Corresponding author

Correspondence to Kamyar Kalantar-Zadeh.

Ethics declarations

This study was approved by the Institutional Review Boards of the Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, University of California Irvine Medical Center, and the University of Washington as exempt from informed consent.

Conflict of interest

K.K.-Z. has received honoraria and/or support from Abbott, Abbvie, Alexion, Amgen, American Society of Nephrology, Astra-Zeneca, AVEO Oncology, Chugai, DaVita, Fresenius, Genentech, Haymarket Media, Hofstra Medical School, International Federation of Kidney Foundations, International Society of Hemodialysis, International Society of Renal Nutrition and Metabolism, Japanese Society of Dialysis Therapy, Hospira, Kabi, Keryx, Novartis, National Institutes of Health, National Kidney Foundation, OPKO, Pfizer, Relypsa, Resverlogix, Sandoz, Sanofi, Shire, Vifor, UpToDate, and ZSPharma.

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Okuda, Y., Obi, Y., Streja, E. et al. Serum albumin and hospitalization among pediatric patients with end-stage renal disease who started dialysis therapy. Pediatr Nephrol 34, 1799–1809 (2019). https://doi.org/10.1007/s00467-019-04270-2

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