Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?

Abstract

BackgroundThe pathogenesis of pulmonary hypertension (PH) in hemodialysis is still unclear. The aim of this study was to identify the risk factors associated with the presence of PH in chronic hemodialysis patients and to verify whether these factors might explain the highest mortality among them.MethodsWe conducted a retrospective study of hemodialysis patients who started treatment from August 2001 to October 2007 and were followed up until April 2011 in a Brazilian referral medical school. According to the results of echocardiography examination, patients were allocated in two groups: those with PH and those without PH. Clinical parameters, site and type of vascular access, bioimpedance, and laboratorial findings were compared between the groups and a logistic regression model was elaborated. Actuarial survival curves were constructed and hazard risk to death was evaluated by Cox regression analysis.ResultsPH > 35 mmHg was found in 23 (30.6%) of the 75 patients studied. The groups differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. In a univariate analysis, extracellular water was associated with PH (relative risk = 1.194; 95% CI of 1.006 – 1.416; p = 0.042); nevertheless, in a multiple model, only left atrium enlargement was independently associated with PH (relative risk =1.172; 95% CI of 1.010 – 1.359; p = 0.036). PH (hazard risk = 3.008; 95% CI of 1.285 – 7.043; p = 0.011) and age (hazard risk of 1.034 per year of age; 95% CI of 1.000 – 7.068; p = 0.047) were significantly associated with mortality in a multiple Cox regression analysis. However, when albumin was taken in account the only statistically significant association was between albumin level and mortality (hazard risk = 0.342 per g/dL; 95% CI of 0.119 – 0.984; p = 0.047) while the presence of PH lost its statistical significance (p = 0.184). Mortality was higher in patients with PH (47.8% vs 25%) who also had a statistically worse survival after the sixth year of follow up.ConclusionsPH in hemodialysis patients is associated with parameters of volume overload that sheds light on its pathophysiology. Mortality is higher in hemodialysis patients with PH and the low albumin level can explain this association.

Pulmonary Hypertension Predicts Adverse Outcomes in Renal Patients: A Systematic Review and Meta‐Analysis

“…Seventeen studies (7566 participants) (15)(16)(17)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) provided quantitative data on the outcomes of interest to be pooled in cumulative meta-analyses. Figure 1 depicts the flow diagram of the study selection process.…”

“…Among the 18 articles included in the review, eight studies (10 525 participants) (18)(19)(20)(21)24,29,30,32) were retrospective and 10 (5273 participants) (15)(16)(17)22,23,(25)(26)(27)(28)31) had a prospective cohort design. Five studies (16,23,24,26,28) focused on nondialysis CKD populations (NKF-KDOQI stages 1-5ND), eight (15,17,22,25,27,(30)(31)(32) were conducted on hemodialysis and two (20,29) on peritoneal dialysis populations. One study investigated a mixed (hemoand peritoneal) dialysis cohort (19) and another (21) considered both pre-dialysis and dialysis patients.…”

Pulmonary hypertension associates with malnutrition and body composition hemodialysis patients

“…Therefore, they could be classified as type 1 malnourished group. Yoo et al 15 reported a higher mortality rate in HD patients with PH who also had low albumin levels than patients with PH and normal albumin levels. They showed lower albumin levels in patients with PH than having normal PAP and suggested that hemodilution as the presumable mechanism to explain the propensity to having lower albumin level in PH group.…”

“…Another prospective study on maintenance of HD patients revealed lower albumin but similar C-reactive protein (CRP) levels in patients with PH than with no pulmonary hypertension. 15 The aim of the present study is to investigate the prevalence of PH and a possible association between pulmonary hypertension and nutritional, biochemical, inflammatory markers, and body composition in long-term HD patients.…”

The impact of serum albumin and serum protein levels on POSSUM score of patients with proximal femur fractures

“…A metaanalysis published by Laulund et al found the following markers as predictors of mortality: low haemoglobin level, low lymphocyte count, low albumin, high creatinine and high PTH [15]. An association between decreased serum albumin and mortality was also found in other medical conditions, among them hemodialysis associated with increased pulmonary hypertension, pressure ulcer onset in intensive care unit patients and community-acquired pneumonia [16][17][18].…”