血液透析的年轻患者与老年患者中，低白蛋白血症与死亡率之间关联的差异。

Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis.

作者信息

Sanz-García Clara, Rodríguez-García Minerva, Górriz-Teruel José Luis, Martín-Carro Beatriz, Floege Jürgen, Díaz-López Bernardino, Palomo-Antequera Carmen, Sánchez-Alvarez Emilio, Gómez-Alonso Carlos, Fernández-Gómez Jesús, Hevia-Suárez Miguel Ángel, Navarro-González Juan Francisco, Arenas María Dolores, Locatelli Francesco, Zoccali Carmine, Ferreira Aníbal, Alonso-Montes Cristina, Cannata-Andía Jorge Benito, Carrero Juan Jesús, Fernández-Martín José Luis

机构信息

H o spital del Oriente de Asturias Francisco Grande Covián. Department of Nephrology, Arriondas, Spain.

Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Bone and Mineral Research Unit, REDinREN (RD06/0016/1013, RD12/0021/0023 and RD16/0009/0017) and RICORS2040 (RD21/0005/0019) del ISCIII, Oviedo, Spain.

出版信息

Clin Kidney J. 2024 Nov 13;18(1):sfae339. doi: 10.1093/ckj/sfae339. eCollection 2025 Jan.

DOI:10.1093/ckj/sfae339

PMID:39781478

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11707383/

Abstract

BACKGROUND

Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin <4.0 g/dl. This study explores whether age might affect serum albumin levels and its association with mortality in haemodialysis patients.

METHODS

COSMOS (Current Management of Secondary Hyperparathyroidism: a Multicentre Observational Study) is a prospective, open-cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality.

RESULTS

The present analysis included 5585 patients. The odds of experiencing hypoalbuminaemia increased with age [adjusted odds ratios = 1.56(95%CI: 1.31-1.86), 1.89(95%CI: 1.59-2.24), 2.68(95%CI: 2.22-3.23) for 56-65, 66-75, and >75 years, respectively (reference ≤55 years; value for trend: <0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years [hazard ratios: 1.36(95%CI: 1.17-1.57) and 1.81(95%CI:1.42-2.31) respectively; value for interaction 0.004]. The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7 g/dl in patients younger than 65 years and 3.5 g/dl in patients 65 years and older.

CONCLUSIONS

Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. Different clinical thresholds that consider age may better discriminate risks associated with hypoalbuminaemia.

摘要

背景

衰老常影响生物标志物的产生。然而，用于指导临床决策的临床/最佳阈值并未考虑这一点。血清白蛋白水平随年龄增长而降低，但低白蛋白血症的定义为血清白蛋白<4.0 g/dl。本研究探讨年龄是否可能影响血液透析患者的血清白蛋白水平及其与死亡率的关联。

方法

COSMOS（继发性甲状旁腺功能亢进的当前管理：一项多中心观察性研究）是一项对血液透析患者进行3年随访的前瞻性、开放队列观察性研究。采用二元逻辑回归和线性回归分析年龄与低白蛋白血症或血清白蛋白（连续变量）之间的关联。采用Cox比例风险多变量回归分析65岁及以上和65岁以下患者低白蛋白血症与死亡率之间的关系。采用时间依赖性受试者工作特征（ROC）曲线评估血清白蛋白预测死亡率的判别能力和最佳阈值。

结果

本分析纳入5585例患者。发生低白蛋白血症的几率随年龄增加而升高[56 - 65岁、66 - 75岁和>75岁的调整比值比分别为1.56（95%CI：1.31 - 1.86）、1.89（95%CI：1.59 - 2.24）、2.68（95%CI：2.22 - 3.23）（参照≤55岁；趋势P值：<0.001）]。生存分析表明，与65岁以下患者相比，65岁及以上患者低白蛋白血症与死亡率之间的关联较弱[风险比分别为1.36（95%CI：1.17 - 1.57）和1.81（95%CI：1.42 - 2.31）；交互作用P值为0.004]。白蛋白水平预测死亡率的能力在年轻患者中始终较高。预测死亡率的最佳白蛋白阈值在65岁以下患者中为3.7 g/dl，在65岁及以上患者中为3.5 g/dl。