Prediction of end-stage renal disease progression and mortality of advanced chronic kidney disease based on one year of serum albumin changes: a retrospective cohort study.

Serum albumin, a marker of nutritional status, is associated with the prognosis of chronic kidney disease (CKD). This study investigated whether dynamic changes in serum albumin provide additional predictive value beyond baseline levels. CKD stages 3b-5 patients receiving regular outpatient follow-up were enrolled. The predictor was the one-year percentage change in serum albumin (ΔAlbumin). Outcomes included incident end-stage renal disease (ESRD) requiring dialysis, the composite of death and incident ESRD, and death before dialysis. The association between the albumin change and dialysis, dialysis or death, and death before dialysis was tested by univariate and multivariable Cox models and restricted cubic spline models. Marginal survival models were conducted to evaluate hazard ratios (HRs) between outcomes. The results showed that the mostly decreasing group (ΔAlbumin < -10.5%) exhibited higher risks of dialysis [HR, 1.58; 95% confidence interval (CI), 1.26-1.98] and dialysis or death (HR, 1.63; 95% CI, 1.38-1.93), while the mostly increasing group (ΔAlbumin >7.7%) showed lower risks of entering ESRD (HR, 0.65; 95% CI, 0.50-0.84) and dialysis or death (HR, 0.66; 95% CI, 0.55-0.80). In restricted cubic spline models, a > 6.5% decrease in serum albumin was associated with a higher risk of dialysis, while a > 5.5% increase was associated with a lower risk. In the marginal survival model, the results showed patients were more likely to receive dialysis before death (HR, 0.74; 95% CI, 0.65-0.84). In conclusion, dynamic changes in serum albumin are closely associated with the prognosis of patients with CKD.