Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis
Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin 75 years, respectively (reference ≤55 years; value for trend:
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| Veröffentlicht in: | Clinical kidney journal 2025-01, Vol.18 (1), p.sfae339 |
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| creator | Sanz-García, Clara Rodríguez-García, Minerva Górriz-Teruel, José Luis Martín-Carro, Beatriz Floege, Jürgen Díaz-López, Bernardino Palomo-Antequera, Carmen Sánchez-Alvarez, Emilio Gómez-Alonso, Carlos Fernández-Gómez, Jesús Hevia-Suárez, Miguel Ángel Navarro-González, Juan Francisco Arenas, María Dolores Locatelli, Francesco Zoccali, Carmine Ferreira, Aníbal Alonso-Montes, Cristina Cannata-Andía, Jorge Benito Carrero, Juan Jesús Fernández-Martín, José Luis |
| description | Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin 75 years, respectively (reference ≤55 years;
value for trend: |
| doi_str_mv | 10.1093/ckj/sfae339 |
| format | Article |
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COSMOS (Current Management of Secondary Hyperparathyroidism: a Multicentre Observational Study) is a prospective, open-cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality.
The present analysis included 5585 patients. The odds of experiencing hypoalbuminaemia increased with age [adjusted odds ratios = 1.56(95%CI: 1.31-1.86), 1.89(95%CI: 1.59-2.24), 2.68(95%CI: 2.22-3.23) for 56-65, 66-75, and >75 years, respectively (reference ≤55 years;
value for trend: <0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years [hazard ratios: 1.36(95%CI: 1.17-1.57) and 1.81(95%CI:1.42-2.31) respectively;
value for interaction 0.004]. The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7 g/dl in patients younger than 65 years and 3.5 g/dl in patients 65 years and older.
Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. Different clinical thresholds that consider age may better discriminate risks associated with hypoalbuminaemia.</description><identifier>ISSN: 2048-8505</identifier><identifier>EISSN: 2048-8513</identifier><identifier>DOI: 10.1093/ckj/sfae339</identifier><identifier>PMID: 39781478</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Original</subject><ispartof>Clinical kidney journal, 2025-01, Vol.18 (1), p.sfae339</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1483-73559a57cd073534b424c57bfa4b0001ab82f361067061b84bce1f3b55c0accd3</cites><orcidid>0000-0002-1248-2858 ; 0000-0002-1683-6617 ; 0000-0001-6543-9960 ; 0000-0003-1424-8659 ; 0000-0001-5593-2209 ; 0000-0002-3300-6033 ; 0000-0002-7505-261X ; 0000-0001-9344-2980 ; 0000-0002-2906-5225 ; 0009-0002-5776-7926 ; 0000-0002-5015-7474 ; 0000-0003-3470-3137 ; 0000-0002-4431-3223 ; 0000-0003-4763-2024 ; 0000-0002-1134-9051 ; 0000-0001-7207-3354 ; 0000-0003-3455-1778</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707383/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707383/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39781478$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanz-García, Clara</creatorcontrib><creatorcontrib>Rodríguez-García, Minerva</creatorcontrib><creatorcontrib>Górriz-Teruel, José Luis</creatorcontrib><creatorcontrib>Martín-Carro, Beatriz</creatorcontrib><creatorcontrib>Floege, Jürgen</creatorcontrib><creatorcontrib>Díaz-López, Bernardino</creatorcontrib><creatorcontrib>Palomo-Antequera, Carmen</creatorcontrib><creatorcontrib>Sánchez-Alvarez, Emilio</creatorcontrib><creatorcontrib>Gómez-Alonso, Carlos</creatorcontrib><creatorcontrib>Fernández-Gómez, Jesús</creatorcontrib><creatorcontrib>Hevia-Suárez, Miguel Ángel</creatorcontrib><creatorcontrib>Navarro-González, Juan Francisco</creatorcontrib><creatorcontrib>Arenas, María Dolores</creatorcontrib><creatorcontrib>Locatelli, Francesco</creatorcontrib><creatorcontrib>Zoccali, Carmine</creatorcontrib><creatorcontrib>Ferreira, Aníbal</creatorcontrib><creatorcontrib>Alonso-Montes, Cristina</creatorcontrib><creatorcontrib>Cannata-Andía, Jorge Benito</creatorcontrib><creatorcontrib>Carrero, Juan Jesús</creatorcontrib><creatorcontrib>Fernández-Martín, José Luis</creatorcontrib><creatorcontrib>COSMOS</creatorcontrib><title>Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis</title><title>Clinical kidney journal</title><addtitle>Clin Kidney J</addtitle><description>Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin <4.0 g/dl. This study explores whether age might affect serum albumin levels and its association with mortality in haemodialysis patients.
COSMOS (Current Management of Secondary Hyperparathyroidism: a Multicentre Observational Study) is a prospective, open-cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality.
The present analysis included 5585 patients. The odds of experiencing hypoalbuminaemia increased with age [adjusted odds ratios = 1.56(95%CI: 1.31-1.86), 1.89(95%CI: 1.59-2.24), 2.68(95%CI: 2.22-3.23) for 56-65, 66-75, and >75 years, respectively (reference ≤55 years;
value for trend: <0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years [hazard ratios: 1.36(95%CI: 1.17-1.57) and 1.81(95%CI:1.42-2.31) respectively;
value for interaction 0.004]. The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7 g/dl in patients younger than 65 years and 3.5 g/dl in patients 65 years and older.
Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. 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Rodríguez-García, Minerva ; Górriz-Teruel, José Luis ; Martín-Carro, Beatriz ; Floege, Jürgen ; Díaz-López, Bernardino ; Palomo-Antequera, Carmen ; Sánchez-Alvarez, Emilio ; Gómez-Alonso, Carlos ; Fernández-Gómez, Jesús ; Hevia-Suárez, Miguel Ángel ; Navarro-González, Juan Francisco ; Arenas, María Dolores ; Locatelli, Francesco ; Zoccali, Carmine ; Ferreira, Aníbal ; Alonso-Montes, Cristina ; Cannata-Andía, Jorge Benito ; Carrero, Juan Jesús ; Fernández-Martín, José Luis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1483-73559a57cd073534b424c57bfa4b0001ab82f361067061b84bce1f3b55c0accd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Original</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sanz-García, Clara</creatorcontrib><creatorcontrib>Rodríguez-García, Minerva</creatorcontrib><creatorcontrib>Górriz-Teruel, José Luis</creatorcontrib><creatorcontrib>Martín-Carro, Beatriz</creatorcontrib><creatorcontrib>Floege, Jürgen</creatorcontrib><creatorcontrib>Díaz-López, Bernardino</creatorcontrib><creatorcontrib>Palomo-Antequera, Carmen</creatorcontrib><creatorcontrib>Sánchez-Alvarez, Emilio</creatorcontrib><creatorcontrib>Gómez-Alonso, Carlos</creatorcontrib><creatorcontrib>Fernández-Gómez, Jesús</creatorcontrib><creatorcontrib>Hevia-Suárez, Miguel Ángel</creatorcontrib><creatorcontrib>Navarro-González, Juan Francisco</creatorcontrib><creatorcontrib>Arenas, María Dolores</creatorcontrib><creatorcontrib>Locatelli, Francesco</creatorcontrib><creatorcontrib>Zoccali, Carmine</creatorcontrib><creatorcontrib>Ferreira, Aníbal</creatorcontrib><creatorcontrib>Alonso-Montes, Cristina</creatorcontrib><creatorcontrib>Cannata-Andía, Jorge Benito</creatorcontrib><creatorcontrib>Carrero, Juan Jesús</creatorcontrib><creatorcontrib>Fernández-Martín, José Luis</creatorcontrib><creatorcontrib>COSMOS</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical kidney journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanz-García, Clara</au><au>Rodríguez-García, Minerva</au><au>Górriz-Teruel, José Luis</au><au>Martín-Carro, Beatriz</au><au>Floege, Jürgen</au><au>Díaz-López, Bernardino</au><au>Palomo-Antequera, Carmen</au><au>Sánchez-Alvarez, Emilio</au><au>Gómez-Alonso, Carlos</au><au>Fernández-Gómez, Jesús</au><au>Hevia-Suárez, Miguel Ángel</au><au>Navarro-González, Juan Francisco</au><au>Arenas, María Dolores</au><au>Locatelli, Francesco</au><au>Zoccali, Carmine</au><au>Ferreira, Aníbal</au><au>Alonso-Montes, Cristina</au><au>Cannata-Andía, Jorge Benito</au><au>Carrero, Juan Jesús</au><au>Fernández-Martín, José Luis</au><aucorp>COSMOS</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis</atitle><jtitle>Clinical kidney journal</jtitle><addtitle>Clin Kidney J</addtitle><date>2025-01</date><risdate>2025</risdate><volume>18</volume><issue>1</issue><spage>sfae339</spage><pages>sfae339-</pages><issn>2048-8505</issn><eissn>2048-8513</eissn><abstract>Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin <4.0 g/dl. This study explores whether age might affect serum albumin levels and its association with mortality in haemodialysis patients.
COSMOS (Current Management of Secondary Hyperparathyroidism: a Multicentre Observational Study) is a prospective, open-cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality.
The present analysis included 5585 patients. The odds of experiencing hypoalbuminaemia increased with age [adjusted odds ratios = 1.56(95%CI: 1.31-1.86), 1.89(95%CI: 1.59-2.24), 2.68(95%CI: 2.22-3.23) for 56-65, 66-75, and >75 years, respectively (reference ≤55 years;
value for trend: <0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years [hazard ratios: 1.36(95%CI: 1.17-1.57) and 1.81(95%CI:1.42-2.31) respectively;
value for interaction 0.004]. The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7 g/dl in patients younger than 65 years and 3.5 g/dl in patients 65 years and older.
Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. Different clinical thresholds that consider age may better discriminate risks associated with hypoalbuminaemia.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>39781478</pmid><doi>10.1093/ckj/sfae339</doi><orcidid>https://orcid.org/0000-0002-1248-2858</orcidid><orcidid>https://orcid.org/0000-0002-1683-6617</orcidid><orcidid>https://orcid.org/0000-0001-6543-9960</orcidid><orcidid>https://orcid.org/0000-0003-1424-8659</orcidid><orcidid>https://orcid.org/0000-0001-5593-2209</orcidid><orcidid>https://orcid.org/0000-0002-3300-6033</orcidid><orcidid>https://orcid.org/0000-0002-7505-261X</orcidid><orcidid>https://orcid.org/0000-0001-9344-2980</orcidid><orcidid>https://orcid.org/0000-0002-2906-5225</orcidid><orcidid>https://orcid.org/0009-0002-5776-7926</orcidid><orcidid>https://orcid.org/0000-0002-5015-7474</orcidid><orcidid>https://orcid.org/0000-0003-3470-3137</orcidid><orcidid>https://orcid.org/0000-0002-4431-3223</orcidid><orcidid>https://orcid.org/0000-0003-4763-2024</orcidid><orcidid>https://orcid.org/0000-0002-1134-9051</orcidid><orcidid>https://orcid.org/0000-0001-7207-3354</orcidid><orcidid>https://orcid.org/0000-0003-3455-1778</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Open Access Collection; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Original |
| title | Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis |
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