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Combined values of serum albumin, C-reactive protein and body mass index at dialysis initiation accurately predicts long-term mortality.
Am J Nephrol. 2012; 36(2):136-43.AJ

Abstract

BACKGROUND

Protein-energy wasting and chronic inflammation are prevalent in patients with end-stage renal disease (ESRD). We investigated the combination of serum albumin, C-reactive protein (CRP) and body mass index (BMI) at initiation of hemodialysis therapy as a predictor of all-cause and cardiovascular disease (CVD) mortality in Japanese ESRD patients.

METHODS

A total of 1,228 consecutive Japanese ESRD patients on hemodialysis therapy were enrolled and followed for up to 10 years. Patients were divided into quartiles according to levels of albumin, CRP and BMI. Furthermore, to clarify the joint role of these factors, albumin <3.5 g/dl, CRP >4.0 mg/l and BMI <19.6 were defined as risk factors using receiver operating characteristic analysis; thereafter, patients were divided into groups according to the positive number of these factors.

RESULTS

Adjusted hazard ratios (HRs) for lower serum albumin, elevated CRP and lower BMI for 10-year all-cause mortality were 1.97, 3.13 and 2.61, respectively. Regarding the combination of these variables, adjusted HRs for mortality were 2.31, 4.28 and 8.07, respectively, in patients having any one factor, any two factors and all three factors. The C-index for an established risk model with these three positive markers was the most accurate for predicting mortality (0.768), as compared to other models with one or two markers. Similar results were seen for CVD mortality.

CONCLUSIONS

Serum albumin, CRP and BMI at the start of hemodialysis therapy were able to individually stratify the risk of long-term mortality in ESRD patients. Furthermore, a combination of these variables could more accurately predict mortality.

Authors+Show Affiliations

Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22813921

Citation

Takahashi, Ryo, et al. "Combined Values of Serum Albumin, C-reactive Protein and Body Mass Index at Dialysis Initiation Accurately Predicts Long-term Mortality." American Journal of Nephrology, vol. 36, no. 2, 2012, pp. 136-43.
Takahashi R, Ito Y, Takahashi H, et al. Combined values of serum albumin, C-reactive protein and body mass index at dialysis initiation accurately predicts long-term mortality. Am J Nephrol. 2012;36(2):136-43.
Takahashi, R., Ito, Y., Takahashi, H., Ishii, H., Kasuga, H., Mizuno, M., Suzuki, Y., Yuzawa, Y., Maruyama, S., Murohara, T., Imai, E., & Matsuo, S. (2012). Combined values of serum albumin, C-reactive protein and body mass index at dialysis initiation accurately predicts long-term mortality. American Journal of Nephrology, 36(2), 136-43. https://doi.org/10.1159/000339940
Takahashi R, et al. Combined Values of Serum Albumin, C-reactive Protein and Body Mass Index at Dialysis Initiation Accurately Predicts Long-term Mortality. Am J Nephrol. 2012;36(2):136-43. PubMed PMID: 22813921.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined values of serum albumin, C-reactive protein and body mass index at dialysis initiation accurately predicts long-term mortality. AU - Takahashi,Ryo, AU - Ito,Yasuhiko, AU - Takahashi,Hiroshi, AU - Ishii,Hideki, AU - Kasuga,Hirotake, AU - Mizuno,Masashi, AU - Suzuki,Yasuhiro, AU - Yuzawa,Yukio, AU - Maruyama,Shoichi, AU - Murohara,Toyoaki, AU - Imai,Enyu, AU - Matsuo,Seiichi, Y1 - 2012/07/18/ PY - 2012/02/21/received PY - 2012/06/04/accepted PY - 2012/7/21/entrez PY - 2012/7/21/pubmed PY - 2013/1/8/medline SP - 136 EP - 43 JF - American journal of nephrology JO - Am J Nephrol VL - 36 IS - 2 N2 - BACKGROUND: Protein-energy wasting and chronic inflammation are prevalent in patients with end-stage renal disease (ESRD). We investigated the combination of serum albumin, C-reactive protein (CRP) and body mass index (BMI) at initiation of hemodialysis therapy as a predictor of all-cause and cardiovascular disease (CVD) mortality in Japanese ESRD patients. METHODS: A total of 1,228 consecutive Japanese ESRD patients on hemodialysis therapy were enrolled and followed for up to 10 years. Patients were divided into quartiles according to levels of albumin, CRP and BMI. Furthermore, to clarify the joint role of these factors, albumin <3.5 g/dl, CRP >4.0 mg/l and BMI <19.6 were defined as risk factors using receiver operating characteristic analysis; thereafter, patients were divided into groups according to the positive number of these factors. RESULTS: Adjusted hazard ratios (HRs) for lower serum albumin, elevated CRP and lower BMI for 10-year all-cause mortality were 1.97, 3.13 and 2.61, respectively. Regarding the combination of these variables, adjusted HRs for mortality were 2.31, 4.28 and 8.07, respectively, in patients having any one factor, any two factors and all three factors. The C-index for an established risk model with these three positive markers was the most accurate for predicting mortality (0.768), as compared to other models with one or two markers. Similar results were seen for CVD mortality. CONCLUSIONS: Serum albumin, CRP and BMI at the start of hemodialysis therapy were able to individually stratify the risk of long-term mortality in ESRD patients. Furthermore, a combination of these variables could more accurately predict mortality. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/22813921/Combined_values_of_serum_albumin_C_reactive_protein_and_body_mass_index_at_dialysis_initiation_accurately_predicts_long_term_mortality_ L2 - https://www.karger.com?DOI=10.1159/000339940 DB - PRIME DP - Unbound Medicine ER -