Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders

Joshua Lang, Ronit Katz, Joachim H. Ix, Orlando M. Gutierrez, Carmen A. Peralta, Chirag Parikh, Suzanne Satterfield, Snezana Petrovic, Prasad Devarajan, Michael Bennett, Linda F. Fried, Steven R. Cummings, Mark J. Sarnak, Michael G. Shlipak

Research output: Contribution to journalArticle

Abstract

Background. Previous studies in HIV-infected individuals have demonstrated serum albumin to be strongly associated with kidney function decline, independent of urine albumin and inflammatory markers. Lower serum albumin concentrations may be an under-appreciated risk factor for kidney function decline in elders. Methods. We performed a cohort analysis in the Health Aging and Body Composition Study, a cohort of well-functioning, biracial, community-dwelling elders between the age of 70 and 79 years. We examined the associations of serum albumin concentration with longitudinal kidney function decline by estimated glomerular filtration rate (EGFR). Outcomes included linear EGFR decline, rapid kidney function decline defined as >30% decrease in EGFR, defined as a final EGFR <60mL/ min/1.73 m2 in those with an EGFR >60mL/min/1.73 m2 at baseline. Cystatin C-based EGFR was calculated at baseline, Year 3 and Year 10. Results. Mean age was 74 years, and mean EGFR was 73mL/ min/1.73 m2 at baseline. The mean rate of EGFR change was 1.81mL/min/1.73 m2 per year. After multivariate adjustment, lower serum albumin concentrations were strongly and independently associated with kidney function decline (-0.11mL/min/1.73 m2 per year for each standard deviation decrease serum albumin; -0.01 to-0.20) with no attenuation after adjustment for urine albumin and inflammatory markers (-0.12, -0.03 to-0.22). When divided into quartiles, serum albumin levels-3.80 g/dL were associated with increased odds of rapid kidney function decline (odds ratio 1.59; 1.12-2.26) and increased risk of incident chronic kidney disease (incident rate ratio 1.29; 1.03-1.62) relative to levels >4.21g/dL. Urine albumin to creatinine ratio (ACR) was also significantly and independently associated with kidney function decline (-0.08mL/min/1.73 m2 per year for urine ACR >30mg/g; -0.82 to-0.13). Conclusions. Lower serum albumin levels are strongly and independently associated with kidney function decline in elders, independent of clinical risk factors, urine albumin and measured inflammatorymarkers.

Original languageEnglish (US)
Pages (from-to)986-992
Number of pages7
JournalNephrology Dialysis Transplantation
Volume33
Issue number6
DOIs
StatePublished - Jun 1 2018

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Chronic Renal Insufficiency
Serum Albumin
Glomerular Filtration Rate
Kidney
Albumins
Urine
Creatinine
Cohort Studies
Independent Living
Cystatin C
Body Composition
Odds Ratio
HIV
Health

Keywords

  • age
  • albumin
  • CKD
  • ESRD
  • inflammation

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders. / Lang, Joshua; Katz, Ronit; Ix, Joachim H.; Gutierrez, Orlando M.; Peralta, Carmen A.; Parikh, Chirag; Satterfield, Suzanne; Petrovic, Snezana; Devarajan, Prasad; Bennett, Michael; Fried, Linda F.; Cummings, Steven R.; Sarnak, Mark J.; Shlipak, Michael G.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 6, 01.06.2018, p. 986-992.

Research output: Contribution to journalArticle

Lang, J, Katz, R, Ix, JH, Gutierrez, OM, Peralta, CA, Parikh, C, Satterfield, S, Petrovic, S, Devarajan, P, Bennett, M, Fried, LF, Cummings, SR, Sarnak, MJ & Shlipak, MG 2018, 'Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders', Nephrology Dialysis Transplantation, vol. 33, no. 6, pp. 986-992. https://doi.org/10.1093/ndt/gfx229
Lang, Joshua ; Katz, Ronit ; Ix, Joachim H. ; Gutierrez, Orlando M. ; Peralta, Carmen A. ; Parikh, Chirag ; Satterfield, Suzanne ; Petrovic, Snezana ; Devarajan, Prasad ; Bennett, Michael ; Fried, Linda F. ; Cummings, Steven R. ; Sarnak, Mark J. ; Shlipak, Michael G. / Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 6. pp. 986-992.
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abstract = "Background. Previous studies in HIV-infected individuals have demonstrated serum albumin to be strongly associated with kidney function decline, independent of urine albumin and inflammatory markers. Lower serum albumin concentrations may be an under-appreciated risk factor for kidney function decline in elders. Methods. We performed a cohort analysis in the Health Aging and Body Composition Study, a cohort of well-functioning, biracial, community-dwelling elders between the age of 70 and 79 years. We examined the associations of serum albumin concentration with longitudinal kidney function decline by estimated glomerular filtration rate (EGFR). Outcomes included linear EGFR decline, rapid kidney function decline defined as >30{\%} decrease in EGFR, defined as a final EGFR <60mL/ min/1.73 m2 in those with an EGFR >60mL/min/1.73 m2 at baseline. Cystatin C-based EGFR was calculated at baseline, Year 3 and Year 10. Results. Mean age was 74 years, and mean EGFR was 73mL/ min/1.73 m2 at baseline. The mean rate of EGFR change was 1.81mL/min/1.73 m2 per year. After multivariate adjustment, lower serum albumin concentrations were strongly and independently associated with kidney function decline (-0.11mL/min/1.73 m2 per year for each standard deviation decrease serum albumin; -0.01 to-0.20) with no attenuation after adjustment for urine albumin and inflammatory markers (-0.12, -0.03 to-0.22). When divided into quartiles, serum albumin levels-3.80 g/dL were associated with increased odds of rapid kidney function decline (odds ratio 1.59; 1.12-2.26) and increased risk of incident chronic kidney disease (incident rate ratio 1.29; 1.03-1.62) relative to levels >4.21g/dL. Urine albumin to creatinine ratio (ACR) was also significantly and independently associated with kidney function decline (-0.08mL/min/1.73 m2 per year for urine ACR >30mg/g; -0.82 to-0.13). Conclusions. Lower serum albumin levels are strongly and independently associated with kidney function decline in elders, independent of clinical risk factors, urine albumin and measured inflammatorymarkers.",
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AU - Lang, Joshua

AU - Katz, Ronit

AU - Ix, Joachim H.

AU - Gutierrez, Orlando M.

AU - Peralta, Carmen A.

AU - Parikh, Chirag

AU - Satterfield, Suzanne

AU - Petrovic, Snezana

AU - Devarajan, Prasad

AU - Bennett, Michael

AU - Fried, Linda F.

AU - Cummings, Steven R.

AU - Sarnak, Mark J.

AU - Shlipak, Michael G.

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N2 - Background. Previous studies in HIV-infected individuals have demonstrated serum albumin to be strongly associated with kidney function decline, independent of urine albumin and inflammatory markers. Lower serum albumin concentrations may be an under-appreciated risk factor for kidney function decline in elders. Methods. We performed a cohort analysis in the Health Aging and Body Composition Study, a cohort of well-functioning, biracial, community-dwelling elders between the age of 70 and 79 years. We examined the associations of serum albumin concentration with longitudinal kidney function decline by estimated glomerular filtration rate (EGFR). Outcomes included linear EGFR decline, rapid kidney function decline defined as >30% decrease in EGFR, defined as a final EGFR <60mL/ min/1.73 m2 in those with an EGFR >60mL/min/1.73 m2 at baseline. Cystatin C-based EGFR was calculated at baseline, Year 3 and Year 10. Results. Mean age was 74 years, and mean EGFR was 73mL/ min/1.73 m2 at baseline. The mean rate of EGFR change was 1.81mL/min/1.73 m2 per year. After multivariate adjustment, lower serum albumin concentrations were strongly and independently associated with kidney function decline (-0.11mL/min/1.73 m2 per year for each standard deviation decrease serum albumin; -0.01 to-0.20) with no attenuation after adjustment for urine albumin and inflammatory markers (-0.12, -0.03 to-0.22). When divided into quartiles, serum albumin levels-3.80 g/dL were associated with increased odds of rapid kidney function decline (odds ratio 1.59; 1.12-2.26) and increased risk of incident chronic kidney disease (incident rate ratio 1.29; 1.03-1.62) relative to levels >4.21g/dL. Urine albumin to creatinine ratio (ACR) was also significantly and independently associated with kidney function decline (-0.08mL/min/1.73 m2 per year for urine ACR >30mg/g; -0.82 to-0.13). Conclusions. Lower serum albumin levels are strongly and independently associated with kidney function decline in elders, independent of clinical risk factors, urine albumin and measured inflammatorymarkers.

AB - Background. Previous studies in HIV-infected individuals have demonstrated serum albumin to be strongly associated with kidney function decline, independent of urine albumin and inflammatory markers. Lower serum albumin concentrations may be an under-appreciated risk factor for kidney function decline in elders. Methods. We performed a cohort analysis in the Health Aging and Body Composition Study, a cohort of well-functioning, biracial, community-dwelling elders between the age of 70 and 79 years. We examined the associations of serum albumin concentration with longitudinal kidney function decline by estimated glomerular filtration rate (EGFR). Outcomes included linear EGFR decline, rapid kidney function decline defined as >30% decrease in EGFR, defined as a final EGFR <60mL/ min/1.73 m2 in those with an EGFR >60mL/min/1.73 m2 at baseline. Cystatin C-based EGFR was calculated at baseline, Year 3 and Year 10. Results. Mean age was 74 years, and mean EGFR was 73mL/ min/1.73 m2 at baseline. The mean rate of EGFR change was 1.81mL/min/1.73 m2 per year. After multivariate adjustment, lower serum albumin concentrations were strongly and independently associated with kidney function decline (-0.11mL/min/1.73 m2 per year for each standard deviation decrease serum albumin; -0.01 to-0.20) with no attenuation after adjustment for urine albumin and inflammatory markers (-0.12, -0.03 to-0.22). When divided into quartiles, serum albumin levels-3.80 g/dL were associated with increased odds of rapid kidney function decline (odds ratio 1.59; 1.12-2.26) and increased risk of incident chronic kidney disease (incident rate ratio 1.29; 1.03-1.62) relative to levels >4.21g/dL. Urine albumin to creatinine ratio (ACR) was also significantly and independently associated with kidney function decline (-0.08mL/min/1.73 m2 per year for urine ACR >30mg/g; -0.82 to-0.13). Conclusions. Lower serum albumin levels are strongly and independently associated with kidney function decline in elders, independent of clinical risk factors, urine albumin and measured inflammatorymarkers.

KW - age

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