Kidney Week

Abstract: FR-PO1062

Declining Serum Albumin in the Shadow of Stable Body Mass Index: A Mortality Indicator in Predialysis CKD

Session Information

• Kidney Nutrition and Metabolism
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Sarav, Menaka, Yale University School of Medicine, New Haven, Connecticut, United States

Menaka Sarav, MD

• Shrestha, Prabin, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• Naseer, Adnan, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Adnan Naseer, MD

• Thomas, Fridtjof, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Fridtjof Thomas, PhD

• Sumida, Keiichi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Kalantar-Zadeh, Kamyar, University of California Los Angeles, Los Angeles, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

Patients with CKD often experience alterations in body composition and nutritional status as their kidney function declines. Body Mass Index (BMI) has been used as a nutritional marker but may not reflect these changes accurately due to concomitant muscle wasting and fluid retention. The role of alternative nutritional measures such as serum albumin in patients with CKD and stable BMI is unclear.

Methods

We analyzed data from a nationwide cohort of 20,164 US Veterans with stable BMI and multiple serum albumin levels who transitioned to kidney replacement therapy from October 2007 through March 2015. We calculated slopes of serum albumin using mixed effects models for three years preceding dialysis. We examined the association of albumin slope with post-dialysis mortality using Cox models adjusted for demographic characteristics, comorbidities, and baseline eGFR and serum albumin.

Results

The cohort had a mean age of 64 years, with 96% male and 30% African American participants. Despite maintaining stable BMI, 81% of patients displayed a decline in serum albumin levels in the pre-dialysis period (median slope: -0.09 g/dl/year, 25th and 75th percentile: -0.17, -0.02). A steeper decline in serum albumin over time was associated with significantly higher post-dialysis mortality (multivariable-adjusted hazard ratio associated with -1 g/dl/year decline in serum albumin: 1.86, 95% confidence interval: 1.65-2.10, p<0.001).

Conclusion

A significant proportion of patients with advanced CKD display a clinically relevant decline in serum albumin despite maintaining a stable BMI. Our study highlights the inadequacy of stable BMI as a marker of nutritional adequacy in advanced CKD, emphasizing the need for comprehensive nutritional assessments in CKD management.

Figure 1. Shows the relationship between serum albumin and hazard rate of death in patients with stable BMI.

Funding

• NIDDK Support