Changes in urine volume and serum albumin in incident hemodialysis patients

Abstract

Introduction Hypoalbuminemia is a predictor of poor outcomes in dialysis patients. Among hemodialysis patients, there has not been prior study of whether residual kidney function or decline over time impacts serum albumin levels. We hypothesized that a decline in residual kidney function is associated with an increase in serum albumin levels among incident hemodialysis patients. Methods In a large national cohort of 38,504 patients who initiated hemodialysis during 1/2007–12/2011, we examined the association of residual kidney function, ascertained by urine volume and renal urea clearance, with changes in serum albumin over five years across strata of baseline residual kidney function, race, and diabetes using case-mix adjusted linear mixed effects models. Findings Serum albumin levels increased over time. At baseline, patients with greater urine volume had higher serum albumin levels: 3.44±0.48, 3.50±0.46, 3.57±0.44, 3.59±0.45, and 3.65±0.46g/dL for urine volume groups of <300, 300-<600, 600-<900, 900-<1200, and ≥1200 mL/day, respectively (Ptrend<0.001). Over time, urine volume and renal urea clearance declined and serum albumin levels rose, while the baseline differences in serum albumin persisted across groups of urinary volume. In addition, the rate of decline in residual kidney function was not associated with the rate of change in albumin. Discussion Hypoalbuminemia in hemodialysis patients is associated with lower residual kidney function. Among incident hemodialysis patients, there is a gradual rise in serum albumin that is independent of the rate of decline in residual kidney function, suggesting that preservation of residual kidney function does not have deleterious impact on serum albumin.

Incremental dialysis for preserving residual kidney function—Does one size fit all when initiating dialysis?

“…24 Gender has a variable association, with one analysis of USRDS data reporting female sex associated with faster RKF decline, 24 whereas another study reported male sex predicted decline in RKF. 42 Comorbid conditions of diabetes, 43 poorly controlled hypertension, and cardiovascular disease have all been reported to predict loss of RKF. Intradialytic hypotension during the first 3 months of dialysis is also associated with RKF decline, as is the presence of proteinuria, even after 6 months after dialysis initiation.…”

Study of the Anti-Diuretic Hormone (ADH) on End Stage Renal Failure Disease (ESRD) Pre-Hemodialysis in Iraqi Patients

“…When renal syndrome occurs, the kidneys stop functioning. Thus, albumin is lost in the urine, leading to a decrease in the level of albumin in the blood [23]. While reduction level of hemoglobin is related with anemia occurs in patients with renal failure because the kidneys are responsible for the secretion of the hormone erythropoietin (EPO), which is responsible for the formation of red blood cells.…”

Toroidal figures of equilibrium from a second-order accurate, accelerated SCF method with subgrid approach

“…3.4), which is transmitted toĤ,ρ, constants C1, C3, C3, V P , etc. This means 4 correct digits typically, which is typical at such a spatial resolution (Eriguchi 1978;Hachisu 1986;Yoshida & Eriguchi 2006). The equilibrium solution is found after 65 iterations.…”

“…Most investigations of selfgravitating tori are, however, performed in classical gravity. Configurations have been computed in details by Hachisu (1986) and collaborators (see also Eriguchi 1978;Hashimoto et al 1993;Lai et al 1993;Kley 1996;Horedt 2004). Despite restrictive assumptions (polytropic gas, symetries, etc.…”