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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Nature Portfolio
2025-08-01
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| Online Access: | https://doi.org/10.1038/s41598-025-07047-w |
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| author | Kazuyoshi Okada Manabu Tashiro Hiroyuki Michiwaki Sumiyo Yamaguchi Tomoko Inoue Takahiro Kuragano Jun Minakuchi |
| author_facet | Kazuyoshi Okada Manabu Tashiro Hiroyuki Michiwaki Sumiyo Yamaguchi Tomoko Inoue Takahiro Kuragano Jun Minakuchi |
| author_sort | Kazuyoshi Okada |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-6bcfa3d531e1404aa6bd3ce0c15c08f3 |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-6bcfa3d531e1404aa6bd3ce0c15c08f32025-08-20T03:04:25ZengNature PortfolioScientific Reports2045-23222025-08-0115111310.1038/s41598-025-07047-wImproved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltrationKazuyoshi Okada0Manabu Tashiro1Hiroyuki Michiwaki2Sumiyo Yamaguchi3Tomoko Inoue4Takahiro Kuragano5Jun Minakuchi6Department of Nephrology, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDepartment of Clinical Engineering, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDivision of Kidney, Dialysis and Cardiology, Department of Internal Medicine, Hyogo College of MedicineDepartment of Nephrology, Kawashima HospitalAbstract 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.https://doi.org/10.1038/s41598-025-07047-wProtein-energy wastingInflammationAlbumin leakageHypoalbuminemiaDialysis |
| spellingShingle | Kazuyoshi Okada Manabu Tashiro Hiroyuki Michiwaki Sumiyo Yamaguchi Tomoko Inoue Takahiro Kuragano Jun Minakuchi Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration Scientific Reports Protein-energy wasting Inflammation Albumin leakage Hypoalbuminemia Dialysis |
| title | Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration |
| title_full | Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration |
| title_fullStr | Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration |
| title_full_unstemmed | Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration |
| title_short | Improved survival with high albumin leakage in patients with protein-energy wasting and inflammation on hemodialysis and online hemodiafiltration |
| title_sort | improved survival with high albumin leakage in patients with protein energy wasting and inflammation on hemodialysis and online hemodiafiltration |
| topic | Protein-energy wasting Inflammation Albumin leakage Hypoalbuminemia Dialysis |
| url | https://doi.org/10.1038/s41598-025-07047-w |
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