Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis
Authors: 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 ,   COSMOS, Marosi Leo , Krankenhaus A Ö , Robl Bernhard , Kiss Heinrich , Neyer Ulrich , Jilly Wilfried , Kramar  , Verbeelen Dierik , Wauters Anne , Cuvelier René , Dratwa Max , Tielemans Christian , Dehout François , Claus Pierre , Dhondt A M , Jeren-Strujic Branka , Gulin Marijana , Coric-Martinovic Valentina , Pavlovic Drasko , Smrzova Jana , Pavlikova  , Valkovsky  , Zahradnik  , Teplan Vladimir , Stranik  , Pavukova  , Moucka  , Otte Overlæge Kjeld , Heaf James , Kolunen Mari , Jean-Baptiste Philit , Nicoud Philippe , Maurice François-Louis , Bounab Mohamed Brahim , Bertocchio Philippe , Jean Guillaume , Chantal Bony , Toledano Daniel , Grimal Pierre , Gaultier Jacques , Mouneimne Alex , Brignon  , Dupuy  , Jaulin Jean-Paul , Urena Pablo , Pocheville Marc , Zins  , Masson Valérie , Uzan Marc , Besnier Dominique , Labeeuw Michel , Glowacki  , Cattanéo  , Didier Ducloux , Bouchouareb  , Philippe Petitjean , Djamel Dahmane , Kim-Seng A N G , Saveanu  , London Gerard , Boussad Bouali , Wambergue François-Pascal , De Fremont J F , Labeeuw Michel , Giraud Patrick , Eche Jean-Paul , Lopez Bernard , Delcroix Catherine , Duchet  , Majdalani Ghandour , Guy  , Hadj  , Guillodo Marie-Paule , Du Questel Z A , Selbach Jochen , Röckel Arnold , Krumme Bernd , Bolley  , Grieger M , Hahn W , Daschner M , Iwig B , Arendt Susanne , Wölbert Bernd , Holzmann  , Graf Guenther , Brockmann Carsten , Brech Wolfgang , Mandelbaum Alexander , Lauerwald Wolfang , Bunia J , Lammer Ulrich , Kurth Carsten , Schnierda  , Stolz  , Harlos J , Berweck S , Brensing Karl-August , Brensing Karl-August , Kreft B , Jahnz Heinrich , Kohnle Wolfgang , Kamen Wilfried , Sodemann  , Nachtigall Peter , Schäffer Jürgen , Leimenstoll  , Stenger Karl-Otmar , Wollschläger  , Langer Christine , Clasen Wolfgang , Röger Christoph , Burkhardt Klaus , Steinbach Jutta , Schulz Walter , Pommer Wolfgang , Baerhausen  , Wilfling Michael , Schmaltz Karla , Eichhorn Michael , Oser Bertil , Müller Eckhard , Striebing Carola , Schobel Hans-Paul , Ludwig Wolfgang , Frei Ulrich , Becker Helmut Peter , Fischer Hans-Christoph , Goller Maximilian , Brückner Dieter , Janning Gottfried , Bagnewski Wolfgang , Preßler Horst , Haufe Christoph , Grützmacher Peter , Miska Hans-Joachim , Lenz Tomas , Hoeft Olaf Frank , Krause Rolfdieter , de Groot Kirsten , Armbruster Helmut , Kalkreuth Klaus , Spellerberg Peter , Stützer Wolfgang , Nikolay Josef , Schmidt Rüdiger , Mann J , Roth Rainer , Lüth Johann-Borwin , Merscher Sybille , Schmidt-Gürtler Hans-Jürgen , Gross Wolfgang , Bethanien Krankenhaus , Dehnert  , Roth  , Floege Jürgen , Ketteler Markus , Heidenreich Stefan , Bahlmann Günter , Loke Olaf , Becker Matthias , Ebbinghaus Rolf , Weiß Matthias , Frye Berhard , Matzkies Fritz , Gebauer Katrin , Schurek H-J , Heck Markus , Hohage Helge , Welling Ullrich , Zeh Matthias , Schwietzer  , Haller Hermann , Selbach Jochen , Caritas-Krankenhaus  , Metz-Kurschel Ulrike , Fulde Roland , Ganzemüller Christoph , Radermacher Jörg , Materna Joachim , Hebgen Oliver , Weber Bernhard , Hummel Dieter , Scheuerle  , Kierdorf Horst , Kierdorf Horst , Beige Joachim , Lorenz R , Braasch Eckhardt , Plakias Dimitrios , Liamos  , Solomakou Stauroula , Bristogiannis Georgios , Kalaitzidis Kleonikos , Kavvadias Dimitrios , Memmos Dimitrios , Papantoniou Antonis , Stamatelou Kyriaki , Stefanidis Ioannis , Siamopoulos Konstantinos , Rikker Csaba , Kulcsár Imre , Tichy Béla , Ferenczi Sandor , Hering Andrea , Árkossy Ottó , Nagy Judit , de Gregorio Ascanio , Frattini Gianmaria , La Corte Antonio , Rotolo Ugo , Brancaccio Diego , Gallieni Maurizio , Fusaro  , Albertazzi Alberto , Randazzo Francesco , Locatelli Francesco , Lodeserto Cosimo , D'Angelo Angela , Frascà Giovanni Maria , Malberti Fabio , Procaccini Aldo , Bianchi Giuseppe , Biagini Marco , Aucella Filippo , Scarlatella Antonio , Farina Marco , Meneghel Ssa Gina , Bonomini Mario , Palla Roberto , Massimo Morosetti , Marinangeli Giancarlo , Santoro Antonio , Munatetto Giorgio , Giordano Pastori , Rossi Giacomino , Cagnoli Leonardo , Cagnoli Leonardo , Morossetti Massimo , Plutino D , Galbiati Alberto , Gesualdo Loreto , Querques Mario , Tommasi Adalberto , Van Bommel E F H , Bos Willem-Jan , Verseput G H , Vleming L , Op De Hoek C T , Van Hamersvelt H W , Hoekstra F , Kaasjager H A H , Durlik Magdalena , Grzeszczyk Miroslav , Rydzewski Andrzej , Sliwicka Dorota , Ostrowski Janusz , Gambro Stacja Dializ , Sydor Antoni , Gauda Tadeusz , Figarska Malgorzata , Trudnowski Slawomir , Matulewicz-Gilewicz Justyna , Sobocki Marek , Felisiak Jacek J , Rutkowski Boleslaw , Rudka Roman , Bidas Kizysztof , Krzywicki Pawel , Hawryluk Jaroslaw , Dziewanowski Krzysztof , Resina Cristina , Carrera Fernando , Maia Pedro Afonso Coelho , Cruz Joao , Ferreira Aníbal , Rocha Ernesto , Alves Doutor Rui , Fernandes João Carlos , Ponce Pedro Magalhaes , Travassos Joao Paulo , Ribeiro Sílvia , Rodrigues Ilídio , Macavei Radu , Covic Adrian , Bako Cristian Gabriel , Alecsandru Radu , Ghenu Adrian , Golea Ovidiu-Sorin , Craciun Irinel , Iacob Ioana , Kralj-Lopert Simona , Malovrh Marko , Benedik Mihael , Ortiz Milagros , Rentero Ramon , Mas Enrique Ajenjo , Gutiérrez Josep Prim , Herrero Guillermina Fernández , de la Torre Mª Josefa , Seguí Rafael Giner , González Juan Navarro , Megido  , Guervas Carlos Santiago , Roldan Carmina Gomez , Otegui Fernando Vidaur , Reyes Guillermo Martín , de Paula de Pedro Antonio , Pérez Pilar Sánchez , López Margarita , Soler Mª Carmen Prados , Gorriz José Luis , Calvo Maria Dolores Paz , Burgos Rafael Romero , Mateos Pedro C Rodrigo , Jimenez Dolores Arenas , Sanz Aurelio , Rogland Björn , Karsberg Margareta , Gutierrez Alberto , Bucht Stig , Burnier Michel , Martin Pierre-Yves , Thomas Kistler , Marone Claudio , Wüthrich Rudolf , Mcclelland Peter , Smithard D , Erekosima Ibi , Goldsmith David , Scoble John , Mark Thomas , Wilkie Martin , Cassidy Mike , Wood Morwenna , Naik Ramesh , Harnett Patrick , FAN Stanley , Bartholomew St , Will Es , Newstead Charles 
Published: November 2024

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 &lt;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 &gt;75 years, respectively (reference ≤55 years; P value for trend: &lt;0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to &lt;65 years [hazard ratios: 1.36(95%CI: 1.17–1.57) and 1.81(95%CI:1.42–2.31) respectively; P 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.