ArticleJournal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation2025
Declining Serum Albumin With Stable Body Mass Index: A Mortality Indicator in Predialysis Chronic Kidney Disease.
Article in Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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Authors and funding
7 authors.
Funding
Abstract
objectiveThis study aimed to investigate changes in nutritional markers in patients with predialysis chronic kidney disease (CKD) and stable body mass index (BMI).
methodsWe analyzed data from a nationwide cohort of US Veterans with advanced CKD who transitioned to kidney replacement therapy from October 1, 2007, through March 31, 2015. We identified 20,164 U.S. veterans with stable BMI and multiple serum albumin measurements. We calculated intraindividual slopes of serum albumin using mixed effects models for 3 years preceding dialysis. We examined the association of serum albumin slope with mortality after dialysis initiation using Cox proportional hazards models adjusted for demographic characteristics, comorbidities, and baseline estimated glomerular filtration rate and serum albumin.
resultsThe cohort had a mean age of 64 years, with 98.3% male and 30% African American participants. Despite maintaining stable BMI, 81% of patients displayed a decline in serum albumin levels in the predialysis 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 postdialysis 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 < .001).
conclusionA large proportion of patients with advanced CKD display a clinically relevant decline in serum albumin despite maintaining a stable BMI. Our study highlights the limitations of stable BMI as a marker of nutritional adequacy in advanced CKD, emphasizing the need for more comprehensive nutritional assessments in CKD management.
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