Department of Medicine, Division of Nephrology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
Department of Medicine, Division of Nephrology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Perit Dial Int. 2019 Nov-Dec;39(6):562-567. doi: 10.3747/pdi.2018.00204. Epub 2019 Mar 9.
Low serum albumin is associated with high mortality in patients with end-stage renal disease (ESRD) on chronic dialysis. Clinicians are reluctant to offer peritoneal dialysis (PD) as an option for dialysis for patients with low serum albumin due to concerns of loss of albumin with PD, but evidence supporting differences in outcomes is limited. We evaluated mortality based on dialysis modality in patients with very low serum albumin (< 2.5 g/dL).We analyzed United States Renal Data System (USRDS) data from 2010 to 2015 to assess mortality by modality adjusted for age, sex, race, employment, number of comorbidities, and year of dialysis initiation.Low serum albumin (< 2.5 g/dL) was present in 78,625 (19.9%) of 395,656 patients with ESRD on chronic dialysis. Patients with low serum albumin were less likely to use PD as their first modality than those with higher albumin (3.1% vs 10.9%; < 0.001). Use of PD was associated with lower mortality compared with hemodialysis (HD) (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.81 - 0.95, < 0.05) in patients with low serum albumin. This difference was more pronounced in patients who had glomerulonephritis (HR = 0.72) or hypertension (HR = 0.81) than in those with end-stage renal disease (ESRD) due to diabetes mellitus or other causes.Peritoneal dialysis is less likely to be the first dialysis modality in patients with low serum albumin requiring dialysis. However, PD is associated with lower mortality than HD in patients with low serum albumin on dialysis. We recommend advocating the use of PD in patients with low serum albumin.
血清白蛋白水平低与慢性透析终末期肾病（ESRD）患者的高死亡率相关。由于担心腹膜透析（PD）会导致白蛋白丢失，临床医生不愿意将 PD 作为低血清白蛋白患者透析的选择，但支持结局差异的证据有限。我们根据非常低的血清白蛋白（<2.5 g/dL）评估了基于透析方式的死亡率。我们分析了 2010 年至 2015 年美国肾脏数据系统（USRDS）的数据，以评估通过调整年龄、性别、种族、就业状况、合并症数量和透析开始年份的方式对死亡率进行调整。在 395656 名接受慢性透析的 ESRD 患者中，78625 名（19.9%）患者的血清白蛋白<2.5 g/dL。与白蛋白水平较高的患者相比，低白蛋白血症患者更不可能首先使用 PD（3.1%比 10.9%；<0.001）。与血液透析（HD）相比，低白蛋白血症患者使用 PD 与死亡率降低相关（风险比[HR] = 0.88，95%置信区间[CI] 0.81-0.95，<0.05）。在患有肾小球肾炎（HR = 0.72）或高血压（HR = 0.81）的患者中，这一差异比患有终末期肾病（ESRD）的患者更为明显，因为糖尿病或其他原因导致 ESRD。对于需要透析的低血清白蛋白患者，PD 不太可能成为首选透析方式。然而，对于透析的低血清白蛋白患者，PD 与 HD 相比与死亡率降低相关。我们建议提倡在低血清白蛋白患者中使用 PD。
