HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rambod, M. Articles by Kalantar-Zadeh, K. Search for Related Content PubMed PubMed Citation Articles by Rambod, M. Articles by Kalantar-Zadeh, K. Agricola Articles by Rambod, M. Articles by Kalantar-Zadeh, K.

Association of serum prealbumin and its changes over time with clinical outcomes and survival in patients receiving hemodialysis^1,2,3,4

¹ From the Harold Simmons Center for Kidney Disease Research and Epidemiology (MR and K-Z), the Division of Nephrology and Hypertension (MR, JDK, and KK-Z), and the Bionutrition Services (RB), General Clinical Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; the Salem Veterans Administration Medical Center, Salem, VA (CPK); and the School of Public Health, University of California, Los Angeles, CA (JDK and KK-Z)

² Parts of this study were presented in the form of abstracts, poster, and oral presentations during the annual meetings of the National Kidney Foundation, April 4–8, 2008, Dallas, TX, and during Clinical Nutrition Week, February 10–13, 2008, Chicago, IL.

³ Supported by the National Institutes of Health, National Institute of Diabetes, Digestive, and Kidney Disease (grants K23DK61162 and R21DK078012), investigator-initiated research grant from Watson and DaVita, and a research grant from the philanthropist Mr. Harold Simmons (all for KK-Z), and the General Clinical Research Center from the National Centers for Research Resources, National Institutes of Health (grant M01RR00425).

⁴ Address reprint requests to K Kalantar-Zadeh, Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90502. E-mail: kamkal{at}ucla.edu.

Background: In patients receiving maintenance hemodialysis (MHD), a low serum prealbumin is an indicator of protein-energy wasting.

Objective:We hypothesized that baseline serum prealbumin correlates independently with health-related quality of life (QoL) and death and that its change over time is a robust mortality predictor.

Design: Associations and survival predictability of serum prealbumin at baseline and its changes over 6 mo were examined in a 5-y (2001–2006) cohort of 798 patients receiving MHD.

Results: Patients with serum prealbumin 40 mg/dL had greater mid-arm muscle circumference but lower percentage of total body fat. Both serum interleukin-6 and dietary protein intake correlated independently with serum prealbumin. Measures of QoL indicated better physical health, physical function, and functionality with higher prealbumin concentrations. Although baseline prealbumin was not superior to albumin in predicting survival, in both all and normoalbuminemic (albumin 3.5 g/dL; n = 655) patients, prealbumin < 20 mg/dL was associated with higher death risk in adjusted models, but further adjustments for inflammatory cytokines mitigated the associations. In 412 patients with baseline prealbumin between 20 and 40 mg/dL whose serum prealbumin was remeasured after 6 mo, a 10-mg/dL fall resulted in a death hazard ratio of 1.37 (95% CI: 1.02, 1.85; P = 0.03) after adjustment for baseline measures, including inflammatory markers.

Conclusions: Even though baseline serum prealbumin may not be superior to albumin in predicting mortality in MHD patients, prealbumin concentrations <20 mg/dL are associated with death risk even in normoalbuminemic patients, and a fall in serum prealbumin over 6 mo is independently associated with increased death risk.

This article has been cited by other articles:

				C. P Kovesdy, S. M George, J. E Anderson, and K. Kalantar-Zadeh Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease Am. J. Clinical Nutrition, August 1, 2009; 90(2): 407 - 414. [Abstract] [Full Text] [PDF]

				R. Shantouf, C. P. Kovesdy, Y. Kim, N. Ahmadi, A. Luna, C. Luna, M. Rambod, A. R. Nissenson, M. J. Budoff, and K. Kalantar-Zadeh Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients Clin. J. Am. Soc. Nephrol., June 1, 2009; 4(6): 1106 - 1114. [Abstract] [Full Text] [PDF]