A Low Serum Albumin Level Predicts Cardiovascular Events in Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Read  full  paper  at:http://www.scirp.org/journal/PaperInformation.aspx?PaperID=54097#.VO14ECzQrzE

Background: Cardiovascular (CV) diseases are the most frequent cause of death in hemodialysis (HD) patients. The aim of this study was to identify risk factors for CV events in HD patients with preserved left ventricular ejection fraction (PEF). Objectives: A total of 213 HD patients (69 years, 64.1% males) were enrolled. Demographic, laboratory test, and echocardiographic data were recorded, and CV events during the 32-month follow-up period were documented. Results: During the follow-up period, 31 patients (14.6%) died and 50 patients (23.5%) suffered a fatal or nonfatal CV event. Age and serum albumin, C-reactive protein, total cholesterol, non-HDL cholesterol, and NT-proBNP levels were associated with CV events according to a univariate analyses. A multivariate analysis identified a low serum albumin value (p < 0.001) as an independent predictor of CV events. A low serum albumin level was also identified as an independent predictor of all-cause mortality (p = 0.0356). Kaplan-Meier curves showed CV events to be more frequent in the group of subjects with the lowest tertile of serum albumin levels (p = 0.0063). Conclusion: A low serum albumin value is an important risk factor for death and CV events in HD patients with PEF.

Cite this paper

Komatsu, M. , Okazaki, M. , Tsuchiya, K. , Kawaguchi, H. and Nitta, K. (2015) A Low Serum Albumin Level Predicts Cardiovascular Events in Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction. International Journal of Clinical Medicine, 6, 85-95. doi: 10.4236/ijcm.2015.62013.

References

[1] Collins, A.J. (2003) Cardiovascular Mortality in End-Stage Renal Disease. American Journal of Medical Sciences, 325, 163-167. http://dx.doi.org/10.1097/00000441-200304000-00002
[2] Nakai, S., Watanabe, Y., Masakane, I., Wada, A., Shoji, T., Hasegawa, T., et al. (2013) Overview of Regular Dialysis Treatment in Japan (as of 31 December 2011). Therapeutic Apheresis and Dialysis, 17, 567-611. http://dx.doi.org/10.1111/1744-9987.12147
[3] Zoccali, C., Benedetto, F.A., Mallamaci, F., Tripepi, G., Giacone, G., Cataliotti, A., et al. (2000) Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients. Journal of American Society of Nephrology, 15, 1029-1037.
http://dx.doi.org/10.1097/01.ASN.0000117977.14912.91
[4] Wang, T.J., Levy, D., Benjamin, E.V. and Vasan, R.S. (2003) The Epidemiology of “Asymptomatic” Left Ventricular Systolic Dysfunction: Implications for Screening. Annals of Internal Medicine, 138, 907-916.
http://dx.doi.org/10.7326/0003-4819-138-11-200306030-00012
[5] Paulus, W.J., Tschope, C., Sanderson, J.E., Rusconi, C., Flachskampf, F.A., Rademakers, F.G., et al. (2007) How to Diagnose Diastolic Heart Failure: A Consensus Statement on the Diagnosis of Heart Failure with Normal Left Ventricular Ejection Fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. European Heart Journal, 28, 2539-2550.
http://dx.doi.org/10.1093/eurheartj/ehm037
[6] Fujiu, A., Ogawa, T., Matsuda, N., Ando, Y. and Nitta, K. (2008) Aortic Arch Calcification and Arterial Stiffness Are Independent Factors for Diastolic Left Ventricular Dysfunction in Chronic Hemodialysis Patients. Circulation Journal, 72, 1768-1772. http://dx.doi.org/10.1253/circj.CJ-08-0308
[7] Tschope, C., Kasner, M., Westermann, D., Gaub, R., Poller, W.C., Schultheiss, H.P., et al. (2005) The Role of NT-proBNP in the Diagnostics of Isolated Diastolic Dysfunction: Correlation with Echocardiographic and Invasive Measurements. European Heart Journal, 26, 2277-2284.
http://dx.doi.org/10.1093/eurheartj/ehi406
[8] Yamazaki, M., Ogawa, T., Tamei, N., Ando, Y. and Nitta, K. (2011) Relation of N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Left Atrial Volume Index to Left Ventricular Function in Chronic Hemodialysis Patients. Heart & Vessels, 26, 421-427. http://dx.doi.org/10.1007/s00380-010-0066-4
[9] Liu, M., Chan, C.P., Yan, B.P., Zhang, Q., Lam, Y.Y., Li, R.J., et al. (2012) Albumin Levels Predict Survival in Patients with Heart Failure and Preserved Ejection Fraction. European Journal of Heart Failure, 14, 39-44.
http://dx.doi.org/10.1093/eurjhf/hfr154
[10] Okazaki, M., Komatsu, M., Kawaguchi, H., Tsuchiya, K. and Nitta, K. (2013) Erythropoietin Resistance Index and the All-Cause Mortality of Chronic Hemodialysis Patients. Blood Purification, 37, 106-112.
http://dx.doi.org/10.1159/000358215
[11] Alberti, K.G. and Zimmet, P.Z. (1998) Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus Provisional Report of a WHO Consultation. Diabetic Medicine, 15, 539-553.
http://dx.doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S
[12] Schiller, N.B. (1991) Two-Dimensional Echocardiographic Determination of Left Ventricular Volume, Systolic Function, and Mass. Summary and Discussion of the 1989 Recommendations of the American Society of Echocardiography. Circulation, 84, 1280-1287.
[13] Schiller, N.B., Shah, P.M., Crawford, M., DeMaria, A., Devereux, R., Feigenbaum, H., et al. (1989) Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Journal of American Society of Echocardiography, 2, 358-367. http://dx.doi.org/10.1016/S0894-7317(89)80014-8
[14] Quinones, M.A., Waggoner, A.D., Reduto, L.A., Nelson, J.G., Young, J.B., Winters Jr., W.L., et al. (1981) A New, Simplified and Accurate Method for Determining Ejection Fraction with Two-Dimensional Echocardiography. Circulation, 64, 744-753. http://dx.doi.org/10.1161/01.CIR.64.4.744
[15] Redfield, M.M., Jacobsen, S.J., Burnett Jr., J.C., Mahoney, D.W., Bailey, K.R. and Rodeheffer, R.J. (2003) Burden of Systolic and Diastolic Ventricular Dysfunction in the Community: Appreciating the Scope of the Heart Failure Epidemic. The Journal of the American Medical Association, 289, 194-202.
[16] Daugirdas, J.T. (1993) Second Generation Logarithmic Estimates of Single-Pool Variable Volume Kt/V: An Analysis of Error. Journal of American Society of Nephrology, 4, 1205-1213.
[17] Bradbury, B.D., Fissell, R.B., Albert, J.M., Anthony, M.S., Critchlow, C.W., Pisoni, R.L., et al. (2007) Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS). Clinical Journal of American Society of Nephrology, 2, 89-99. http://dx.doi.org/10.2215/CJN.01170905
[18] Kato, A., Takita, T., Furuhashi, M., Maruyama, Y. and Hishida, A. (2010) Comparison of Serum Albumin, C-Reactive Protein and Carotid Atherosclerosis as Predictors of 10-Year Mortality in Hemodialysis Patients. Hemodialysis International, 14, 226-232. http://dx.doi.org/10.1111/j.1542-4758.2009.00432.x
[19] Herselman, M., Esau, N., Kruger, J.M., Labadarios, D. and Moosa, M.R. (2010) Relationship between Serum Protein and Mortality in Adults on Long-Term Hemodialysis: Exhaustive Review and Meta-Analysis. Nutrition, 26, 10-32.
http://dx.doi.org/10.1016/j.nut.2009.07.009
[20] de Mutsert, R., Grootendorst, D.C., Indemans, F., Boeschoten, E.W., Krediet, R.T., Dekker, F.W., et al. (2009) Association between Serum Albumin and Mortality in Dialysis Patients Is Partly Explained by Inflammation, and Not by Malnutrition. Journal of Renal Nutrition, 19, 127-135.
http://dx.doi.org/10.1053/j.jrn.2008.08.003
[21] Fouque, D., Kalantar-Zadeh, K., Kopple, J.D., Cano, N., Chauveau, P., Cuppari, L., et al. (2008) A Proposed Nomenclature and Diagnostic Criteria for Protein-Energy Wasting in Acute and Chronic Kidney Disease. Kidney International, 73, 391-398. http://dx.doi.org/10.1038/sj.ki.5002585
[22] Kovesdy, C.P. and Kalantar-Zadeh, K. (2009) Why Is Protein-Energy Wasting Associated with Mortality in Chronic Kidney Disease? Seminars in Nephrology, 29, 3-14.
http://dx.doi.org/10.1016/j.semnephrol.2008.10.002
[23] Kalantar-Zadeh, K., Kilpatrick, R.D., Kuwae, N., McAllister, C.J., Alcorn Jr., H., Kopple, J.D., et al. (2005) Revisiting Mortality Predictability of Serum Albumin in the Dialysis Population: Time Dependency, Longitudinal Changes and Population-Attributable Fraction. Nephrology Dialysis Transplantation, 20, 1880-1888. http://dx.doi.org/10.1093/ndt/gfh941
[24] Bonanni, A., Mannucci, I., Verzola, D., Sofia, A., Saffoti, S., Gianetta, E., et al. (2011) Protein-Energy Wasting and Mortality in Chronic Kidney Disease. International Journal of Environmental Research and Public Health, 8, 1631-1654.
http://dx.doi.org/10.3390/ijerph8051631
[25] Kalantar-Zadeh, K., Anker, S.D., Horwich, T.B. and Fonarow, G.C. (2008) Nutritional and Anti-Inflammatory Interventions in Chronic Heart Failure. American Journal of Cardiology, 101, S89-S103.
http://dx.doi.org/10.1016/j.amjcard.2008.03.007
[26] Horwich, T.B., Kalantar-Zadeh, K., MacLellan, R. and Fonarow, G. (2008) Albumin Level Predicts Survival in Patients with Systolic Heart Failure. American Heart Journal, 155, 883-889.
http://dx.doi.org/10.1016/j.ahj.2007.11.043
[27] Yamamoto, K., Sakata, Y., Ohtani, T., Takeda, Y. and Mano, T. (2009) Heart Failure with Preserved Ejection Fraction. Circulation Journal, 73, 404-410. http://dx.doi.org/10.1253/circj.CJ-08-1073
[28] Pecoits-Filho, R., Bucharles, S. and Barberato, S.H. (2012) Diastolic Heart Failure in Dialysis Patients: Mechanisms, Diagnostic Approach, and Treatment. Seminars in Dialysis, 25, 35-41.
http://dx.doi.org/10.1111/j.1525-139X.2011.01011.x
[29] Quiroga, B., Villaverde, M., Abad, S., Vega, A., Reque, J. and Lopez-Gomez, J.M. (2013) Diastolic Dysfunction and High Levels of New Cardiac Biomarkers as Risk Factors for Cardiovascular Events and Mortality in Hemodialysis Patients. Blood Purification, 36, 98-106. http://dx.doi.org/10.1159/000354080
[30] Carfray, A., Patel, K., Whitaker, P., Garrick, P., Griffiths, G.J. and Warwick, G.L. (2000) Albumin as an Outcome Measure in Haemodialysis in Patients: The Effect of Variation in Assay Method. Nephrology Dialysis Transplantation, 15, 1819-1822. http://dx.doi.org/10.1093/ndt/15.11.1819                eww150225lx
Advertisements

发表评论

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / 更改 )

Twitter picture

You are commenting using your Twitter account. Log Out / 更改 )

Facebook photo

You are commenting using your Facebook account. Log Out / 更改 )

Google+ photo

You are commenting using your Google+ account. Log Out / 更改 )

Connecting to %s