Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients

Pereira, Giselly Rosa Modesto; Strogoff-de-Matos, Jorge Paulo; Ruzany, Frederico; Santos, Sérgio F.; Filho, Eufrônio D ́Almeida; Vasconcelos, Marcos Sandro Fernandes de; Barra, Ana Beatriz Lesqueves; Lugon, Jocemir Ronaldo

doi:10.5935/0101-2800.20150032

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…The poorer control of hypertension in AAs (who are genetically related to our study population) coupled with poor compliance with the use of BP lowering drugs, is expected to produce lower dialysis doses, higher extraction ratio, IDWG and ultrafiltration volume [29]. The inverse relationship between the UFV and the predialysis values of serum albumin, bicarbonate and haematocrit in our study mirror findings from studies that reported that the extraction ration, IDWG and UFV increases with derangement in serum biochemical parameters [29][30][31]. Prolonged dialysis session allow for reductions in UFR in those prone to IDH, the lower dose from this is compensated for by increased dose from dialysis prolongation hence preventing IDH is worth it [25].…”

Section: Discussionsupporting

confidence: 78%

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Kehinde¹,

Omotola²,

Igwebuike³

et al. 2021

J Clin Nephrol Ren Care

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Background:The ultrafiltration volume, a surrogate maker of inter-dialytic weight gain and extraction ratio plays a significant contributory role in the dialysis dose but in very large amount can lead to intradialysis hypotension and its consequences of myocardial ischemia and stunning and further diminution of kidney function. Measures are needed to prescribe the optimal quantity for each session.Method: A thousand six hundred and eighty eight dialysis sessions for 287 participants were studied. Pre and postdialysis blood samples for electrolytes, urea and creatinine, and hematocrit were taken. Results:The mean age, interdialytic weight gain and ultrafiltration volume were 50.7 ± 11.7 years, 2.23 ± 1.3 kg and 1.3 ± 1.1 L respectively. Greater proportions of participants were males (66.9%), had hypertension associated CKD (44.6%) and were between 35-54 years (44.3%). A greater proportion of the sessions had ultrafiltration volume 1500-1999 mL (23.6%). The ultrafiltration volume was higher in males, was positively related to the inter-dialytic weight gain, fall in interdialytic percentage oxygen saturation and inter-dialytic blood pressure rise but it was negatively correlated with age, predialysis albumin and bicarbonate, blood flow rate, dialysis duration, and dialysis dose (higher in males). Higher ultrafiltration volume was associated with intradialysis hypotension. Dialysis dose was adequate in 15.2% of the sessions. Predictors of the ultrafiltration volume were dialysis frequency, blood flow rate, dialysis duration, predialysis albumin and dialysis dose. Conclusion:The ultrafiltration volume contributes to the dialysis dose but very high quantity could cause intradialysis hypotension. A carefully prescribed ultrafiltration volume is therefore needed to deliver optimal treatment doses and avoid complications.

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Section: Discussionsupporting

confidence: 78%

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Kehinde¹,

Omotola²,

Igwebuike³

et al. 2021

J Clin Nephrol Ren Care

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“…In this regard, our study indicates that total circulating albumin as well as essential electrolytes in plasma, except K + , are substantially decreased following HD. The current observation that circulating albumin, a strong mortality risk factor in ESRD patients, [2][3][4][5] is reduced by HD in proportion to PV withdrawal merits particular attention. According to regression analyses, for every liter of plasma removed by HD, approximately 40 g of albumin, i.e., one third of total circulating albumin, are lost from the intravascular compartment.…”

Section: Discussionmentioning

confidence: 98%

“…In patients with end‐stage renal disease (ESRD), abnormally low plasma albumin limits fluid shifts from edematous tissues into the circulation, where excess fluid can be removed via the hemodialysis (HD) procedure. Importantly, hypoalbuminemia (hALB) is a strong prognostic factor of death and cardiovascular complications in ESRD patients 2–5 …”

Section: Introductionmentioning

confidence: 99%

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Intravascular albumin loss is strongly associated with plasma volume withdrawal in dialysis patients

Haider

Díaz-Cañestro

Pentz

et al. 2020

Hemodialysis International

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Introduction Low circulating albumin closely predicts mortality in end‐stage renal disease (ESRD) patients. The cause(s) of hypoalbuminemia (hALB) in ESRD patients remains to be elucidated. The aim of the present study was to determine the role of plasma volume (PV) withdrawal in the reduction of total circulating albumin and essential blood solutes induced by hemodialysis (HD). Methods PV determined with high‐precision automated carbon monoxide‐rebreathing, total circulating as well as concentration of plasma albumin and electrolytes were assessed prior to and after 4‐hour HD in 10 ESRD patients. Findings Baseline PV ranged from 3.5 to 6.2 l. After HD, PV was decreased by 689 ± 566 mL (−16%) (P = 0.004). Total circulating albumin was largely reduced after HD (170.8 ± 35.1 vs. 146.1 ± 48.9 g, P = 0.008), while albumin concentration was unaltered. According to a strong linear relationship (r = 0.91, P < 0.001), one‐third of total circulating albumin is lost from the intravascular compartment for every liter of PV removed. Similar results were found regarding Na+ and Ca2+ electrolytes. Discussion Total circulating albumin, but not albumin concentration, is substantially reduced by HD in proportion to the amount of PV removed from the circulation. This study highlights the potential contributing role of PV withdrawal to hALB in ESRD patients.

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“…The KDOQI guidelines recommend timely nephrology referral, nutritional consultation, fistula placement for dialysis access, control of anemia, acidosis, and mineral and bone metabolism parameters [5]. Several studies suggest that there is a significant correlation between the number of KDOQI guidelines with survival and quality of life [6][7][8], at least in the first year after the initiation of renal replacement therapy [9]. However, only 1.6% of patients with ESRD on hemodialysis achieve 3 goals [1,10].…”

Section: Introductionmentioning

confidence: 99%

Quality of Care in Long-Term Hemodialysis Patients in Mexico

JA¹,

Jg²,

JA³

et al. 2021

austinjnephrolhypertens

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Introduction: The End Stage Renal Disease (ESRD) is one of the leading causes of mortality in Mexico. The quality of care these patients receive remains uncertain. Methods: This is a descriptive, single-center and cross-sectional cohort study. The KDOQI performance measures, hemoglobin level >11 g/dL, blood pressure <140/90 mmHg, serum albumin >4 g/dL and use of arteriovenous fistula of patients with ESRD on hemodialysis were analyzed in a period of a year. The association between mortality and the KDOQI objectives was evaluated with a logistic regression model. A linear regression model was also performed with the number of readmissions. Results: A total of 124 participants were included. Participants were categorized by the number of measures completed. Fourteen (11.3%) of the participants did not meet any of the goals, 51 (41.1%) met one, 43 (34.7%) met two, 11 (8.9%) met three, and 5 (4%) met the four clinical goals analyzed. A mortality of 11.2% was registered. In the logistic regression model, the number of goals met had an OR for mortality of 1.1 (95% CI 0.5-2.8). In the linear regression model, for the number of readmissions, a beta correlation with the number of KDOQI goals met was 0.246 (95% CI -0.872-1.365). Conclusion: The attainment of clinical goals and the mortality rate in our center is similar to that reported in the world literature. Our study did not find a significant association between compliance with clinical guidelines and mortality or the number of hospital admissions in CKD patients on hemodialysis.

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Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients

Cited by 4 publications

References 22 publications

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Intravascular albumin loss is strongly associated with plasma volume withdrawal in dialysis patients

Quality of Care in Long-Term Hemodialysis Patients in Mexico

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