Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration

Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration

Abstract Albumin leakage (Alb-L) and serum albumin (S-Alb) levels are predictors of mortality in dialysis patients. Because protein-energy wasting (PEW) and inflammation reduce hepatic albumin synthesis, we hypothesized that mortality would differ based on Alb-L and/or S-Alb levels, depending on the...

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Main Authors: Kazuyoshi Okada, Manabu Tashiro, Hiroyuki Michiwaki, Sumiyo Yamaguchi, Tomoko Inoue, Takahiro Kuragano, Jun Minakuchi
Format: Article
Language:English
Published: Nature Portfolio 2025-08-01
Series:Scientific Reports
Subjects:
Protein-energy wasting
Inflammation
Albumin leakage
Hypoalbuminemia
Dialysis
Online Access:https://doi.org/10.1038/s41598-025-07047-w
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Summary:Abstract Albumin leakage (Alb-L) and serum albumin (S-Alb) levels are predictors of mortality in dialysis patients. Because protein-energy wasting (PEW) and inflammation reduce hepatic albumin synthesis, we hypothesized that mortality would differ based on Alb-L and/or S-Alb levels, depending on the presence of PEW and inflammation. This retrospective study included 738 super high-flux hemodialysis (SHF HD) and online hemodiafiltration (OHDF) patients. Three-year all-cause mortality was compared in patients without PEW and inflammation (Group 1) and with PEW and/or inflammation (Group 2) using a propensity score matching model and Cox regression analysis with adjustment. In Group 2, mortality in patients with “high Alb-L” or “high S-Alb” was significantly lower in comparison to low groups, but not in Group 1. In Group 2, mortality in the “high Alb-L” and “high S-Alb (3.5 ± 0.2 g/dL)” group was lower than in other groups, including Group 1, except for the “high Alb-L” and “low S-Alb (3.2 ± 0.2 g/dL)” group, which had no deaths. In SHF HD and OHDF patients with PEW and/or inflammation, “high Alb-L” with normoalbuminemia to mild hypoalbuminemia improved survival to a level similar to patients without PEW and inflammation. Additionally, Alb-L and/or S-Alb had little impact on mortality in patients without PEW and inflammation.
ISSN:2045-2322

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