Nephrology Dialysis Transplantation, Vol 12, Issue 3 554-558, Copyright © 1997 by Oxford University Press
CH Jones, CG Newstead, EJ Wills and AM Davison
HYPOTHESIS: Trends in serum albumin concentration over time provide a
better prediction of clinical outcome in CAPD patients than a single mean
value. METHODS: This was a retrospective review of outcome at 36 months in
225 adult CAPD patients. Mean serum albumin was determined for the first
(SA1) and second (SA2) 6 months of treatment and patients grouped according
to SA1 (group I, > 37; group II, 34-37; group III, < 34 g/l) and
according to the change in serum albumin (delta SA) between the first and
second 6 months (increased/static or decreased). Patient (PS) and technique
(TS) survival were determined by Kaplan-Meier survival analysis. The effect
of SA1 and delta SA on survival were determined in a multivariate Cox
regression analysis model that included age and presence or absence of a
systemic disease. RESULTS: By SA1 group, PS and TS survival at 36 months
were 94 and 76% (group I), 64 and 53% (group II) and 70 and 52% (group
III). If delta SA increased/remained static, then SA1 did not predict PS
(group I, 100%; group II, 96%; group III, 74%; P = n.s.) or TS (group I,
72%; group II, 63%; group III, 65%; P = n.s.). If delta SA decreased, PS
was worse in groups II and III, both as compared to group I (PS group I,
88%; group II, 52%; group III, 34%; P = 0.02) and as compared to the groups
II and III when delta SA increased (PS group II, 74 vs 52%, P = 0.05; group
III, 82 vs 34%, P = 0.005) The same trend was seen for TS. In the
multivariate Cox regression model, age, direction of change in serum
albumin, and presence of a multisystem disease were significant predictors
of survival, whereas SA1 was not. CONCLUSION: Early hypoalbuminaemia in
CAPD only predicts a worse patient and technique survival if mean serum
albumin decreases further from the first to second 6 months of dialysis
therapy. Change in serum albumin between the first and second 6 months of
CAPD and the mean serum albumin over the first 6 months together offer
better discrimination of outcome than either alone.
ORIGINAL ARTICLES
Serum albumin and survival in CAPD patients: the implications of concentration trends over time
Department of Renal Medicine, St James's University Hospital, Leeds, UK.
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