Fig 2 - available via license: Creative Commons Attribution 4.0 International
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Changes in serum albumin level during continuous renal replacement therapy in the four albumin groups: orange, persistently high; green, increasing; purple, decreasing; blue, persistently low. Numbers at the bottom of the figure indicate the number of data available for each group on each day
Source publication
Background
Hypoalbuminemia at the initiation of continuous renal replacement therapy (CRRT) is a risk factor for poor patient outcomes. However, it is unknown whether the patterns of changes in serum albumin levels during CRRT can be used to predict patient outcomes.
Methods
This retrospective study analyzed data that had been consecutively collec...
Context in source publication
Context 1
... of CRRT was 3.05 ± 0.67 g/dL. Serum albumin levels changed during the median of 5 (3-8) days of CRRT. Among the 793 included patients, serum albumin levels were persistently low in 299 (37.7%), increased in 85 (10.4%), decreased in 195 (24.6%), and persistently high in 214 (27.0%). Changes in the serum albumin level in each group are plotted in Fig. 2. In the decreasing and increasing groups, serum albumin levels started to change on the second day of CRRT, and on the third day (day 3) of CRRT, mean serum albumin levels were highest in the persistently high, followed by the increasing, decreasing, and the persistently low group. At the end of CRRT, the mean serum albumin level in ...
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Citations
... This association persisted even after adjustment for potential confounders like age, sex, and comorbidities, with an adjusted HR of 2.0 (14). These results align with previous research, reinforcing the notion that hypoalbuminemia is not merely a marker of malnutrition but also indicative of inflammation and systemic organ dysfunction, which can exacerbate the severity of heart failure and its associated comorbidities (15,16). ...
Background: Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization with significant morbidity and mortality. Hypoalbuminemia has been identified as a potential prognostic factor in various medical conditions, including heart failure. Understanding its association with in-hospital mortality in ADHF patients could enhance risk assessment and management strategies. Objective: This study aimed to investigate the association of hypoalbuminemia with in-hospital mortality in patients admitted with ADHF. Methods: This was a retrospective observational study conducted at a tertiary cardiac care center in Rawalpindi between July and November 2023. A total of 480 patients with a confirmed diagnosis of ADHF were included. Inclusion criteria were age ≥ 18 years, confirmed ADHF diagnosis, and available serum albumin levels upon admission. Exclusion criteria included incomplete medical records, end-stage renal disease, active malignancies, acute liver disease, and acute infectious diseases. Data on demographics, clinical characteristics, and serum albumin levels were collected. Logistic regression analysis was used to assess the association between hypoalbuminemia (defined as serum albumin <3.0 g/dL) and in-hospital mortality, adjusting for confounders like age, sex, and comorbidities. Results: The cohort comprised 60% males and 40% females, with a mean age of 68 years. Hypertension (78%), diabetes (42%), and chronic kidney disease (36%) were the most prevalent comorbidities. The mean serum albumin level was 3.2 g/dL (SD = 0.4). Hypoalbuminemia was observed in 42% of patients. In-hospital mortality was 15%. Patients with hypoalbuminemia had a 2.5-fold increased risk of in-hospital mortality (unadjusted HR = 2.5, p < 0.001). The adjusted HR was 2.0 (p < 0.01), indicating hypoalbuminemia as an independent predictor of in-hospital mortality. Conclusion: Hypoalbuminemia is significantly associated with increased in-hospital mortality in patients with ADHF, serving as an independent prognostic indicator. This finding highlights the importance of serum albumin in the risk assessment and management of ADHF patients.
... Fifteen articles were downloaded and their full-texts were analyzed. Five fulfilled the inclusion criteria and were included in the review [18][19][20][21][22]. ...
The review aimed to assess if hypoalbuminemia can predict mortality in patients undergoing continuous renal replacement therapy (CRRT). PubMed, Web of Science, Embase, and CENTRAL were searched for relevant articles published up to 24 July 2022. Adjusted data were pooled to calculate the odds ratio (OR). Sensitivity and meta-regression analysis was conducted. Five studies with 5254 patients were included. Meta-analysis of all five studies demonstrated that hypoalbuminemia was a significant predictor of mortality after CRRT (OR: 1.31 95% CI: 1.07, 1.60 I2 = 72% p = 0.01). The results did not change on sensitivity analysis. On meta-regression, we noted that variables like age, male gender, BMI, percentage of diabetics, and pre-CRRT SOFA score had no statistically significant influence on the outcome. Data from a limited number of studies suggest that hypoalbuminemia before initiation of CRRT is an independent predictor of early mortality. Based on current evidence, it may be suggested that patients with low albumin levels initiating CRRT should be prioritized and treated aggressively to reduce adverse outcomes.
... We performed CRRT in continuous veno-venous hemodia ltration mode. The details of our CRRT methods are described elsewhere 28,29 . A decision to stop CRRT was made by a nephrologist when signs of renal recovery were observed, the volume of spontaneous urine output increased by > 200-500 mL/day, or the disease burden was to an extent that it could be controlled by the patient 30 . ...
Background
We hypothesized that a low mean arterial pressure (MAP) at CRRT initiation would influence the early death or withdrawal of CRRT and in-hospital mortality.
Methods
This prospective cohort study collected data for CRRT patients seen at the Third Affiliated Hospital from January 2016 to December 2020. We collected MAP data at the initiation of CRRT, reasons for CRRT termination, and in-hospital mortality data. We divided the patients into four groups based on quartiles of the initial MAP and analyzed its influence on early death/withdrawal of CRRT.
Results
A total of 2,346 patients with acute kidney injury (AKI) were included in this study. The median age of the participants was 68.0 (57.0–76.0) years, and 62.4% were male. CRRT was discontinued in 49.9% of our patients after renal recovery or HD transition; in 48.8%, CRRT was terminated by death (36.6%) or withdrawal (12.2%). An initial low MAP (Q1, MAP ≤ 69 mmHg and Q2, MAP ≤ 77.1 mmHg) was associated with a 1.3-fold greater risk of death/withdrawal during CRRT. Older age, a higher SOFA score, and oliguria at the time of CRRT initiation also predicted death/withdrawal during CRRT.
Conclusions
In patients on CRRT, a lower MAP at CRRT initiation was closely associated with a higher probability of terminating CRRT due to death/withdrawal, and it was associated with an increased risk of in-hospital mortality.
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The relationship between albumin corrected anion gap (ACAG) and mortality in acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) has not been investigated in any previous studies. This study aimed to investigate the relationship between ACAG at CRRT initiation and all-cause mortality among these patients in the intensive care unit (ICU). Patients diagnosed with AKI and treated with CRRT in the ICU from the Medical Information Mart for Intensive Care-IV version 1.0 (MIMIC IV) database and Huzhou Central Hospital were retrospectively enrolled. Participants were divided into two groups: the normal ACAG group (12–20 mmol/L) and high ACAG group (> 20 mmol/L). The Kaplan–Meier method and log-rank test were used to compare the survival rate between the two groups. Restricted cubic spine (RCS) and Cox proportional-hazards models were utilized to analyze the relationship between ACAG at CRRT initiation and ICU all-cause mortality of these patients. A total of 708 patients met the inclusion criteria in the study. The all-cause mortality of these patients during ICU hospitalization was 41.95%. Patients in the high ACAG group exhibited significantly higher ICU all-cause mortality rate than patients in the normal ACAG group (all P < 0.001). The Kaplan–Meier survival curves showed that the normal ACAG group had a higher ICU cumulative survival rate than the high ACAG group (log-rank test, χ 1 2 = 13.620, χ 2 ² = 12.460, both P < 0.001). In the multivariate COX regression analyses, patients with higher ACAG (> 20 mmol/L) levels at the time of CRRT initiation in the MIMIC IV database and Huzhou Central Hospital were significantly correlated with ICU all-cause mortality after adjusting multiple potential confounding factors with hazard ratios of 2.852 (95% CI 1.718–4.734) and 2.637(95% CI 1.584–4.389), respectively. In critically AKI patients who undergo CRRT, higher ACAG (> 20 mmol/L) level at the initiation of CRRT was significantly correlated with ICU all-cause mortality. Therefore, clinicians should pay more attention to those patients with a higher ACAG value.
