Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation · 2026
Longitudinal Trajectories of Serum Prealbumin and Their Association With Mortality in Maintenance Hemodialysis Patients.
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Li Jiaxin, Zhang Xiaoqin, Lv Honghong
Аннотация
OBJECTIVES: Protein-energy wasting is a leading driver of mortality in maintenance hemodialysis (MHD) patients. Current nutritional assessment relies heavily on serum albumin, a lagging indicator that often masks active nutritional deterioration until stores are significantly depleted. While serum prealbumin offers higher sensitivity, it is frequently dismissed as merely a surrogate for systemic inflammation. It remains unclear whether the longitudinal velocity of prealbumin decline provides prognostic information beyond static markers, average concentration levels, and the acute phase response.
METHODS: We conducted a retrospective cohort study of 326 prevalent MHD patients with 3,137 serial prealbumin measurements (median follow-up 2.25 years; average 9.62 measurements per patient). Longitudinal trajectories were identified using a two-stage approach combining linear mixed-effects modeling and K-means clustering. Associations were assessed using sequential multivariable Cox proportional hazards models adjusted for demographics, diabetes mellitus, cardiovascular disease, baseline serum albumin, high-sensitivity C-reactive protein, hemoglobin, phosphate, urea reduction ratio, and time-average prealbumin. Multiple imputation by chained equations was employed to handle missing covariates, ensuring the inclusion of the full cohort (N = 326) in all multivariable models.
RESULTS: Three distinct trajectory phenotypes were identified: rapid decline (16.6%), moderate decline (66.0%), and stable/up (17.5%). Notably, patients in the rapid decline phenotype had clinically normal baseline serum albumin levels (mean 39.9 g/L). During follow-up, 116 deaths occurred. Crude mortality rates demonstrated a clear gradient: 4.26, 14.2, and 19.2 per 100 person-years for the stable/up, moderate, and rapid decline groups, respectively. In the fully adjusted model incorporating TA-Prealbumin, the rapid decline trajectory remained a potent indicator of mortality (model 4: hazard ratio: 2.29; 95% confidence interval: 0.99-5.34; P = .054).
CONCLUSIONS: The velocity of prealbumin decline unmasks high-risk phenotypes of protein-energy wasting and nutritional deterioration overlooked by traditional static assessments. Integrating trajectory monitoring into routine care shifts the paradigm from treating the "value" to treating the "trend," acting as an independent associative marker for mortality in MHD patients.
METHODS: We conducted a retrospective cohort study of 326 prevalent MHD patients with 3,137 serial prealbumin measurements (median follow-up 2.25 years; average 9.62 measurements per patient). Longitudinal trajectories were identified using a two-stage approach combining linear mixed-effects modeling and K-means clustering. Associations were assessed using sequential multivariable Cox proportional hazards models adjusted for demographics, diabetes mellitus, cardiovascular disease, baseline serum albumin, high-sensitivity C-reactive protein, hemoglobin, phosphate, urea reduction ratio, and time-average prealbumin. Multiple imputation by chained equations was employed to handle missing covariates, ensuring the inclusion of the full cohort (N = 326) in all multivariable models.
RESULTS: Three distinct trajectory phenotypes were identified: rapid decline (16.6%), moderate decline (66.0%), and stable/up (17.5%). Notably, patients in the rapid decline phenotype had clinically normal baseline serum albumin levels (mean 39.9 g/L). During follow-up, 116 deaths occurred. Crude mortality rates demonstrated a clear gradient: 4.26, 14.2, and 19.2 per 100 person-years for the stable/up, moderate, and rapid decline groups, respectively. In the fully adjusted model incorporating TA-Prealbumin, the rapid decline trajectory remained a potent indicator of mortality (model 4: hazard ratio: 2.29; 95% confidence interval: 0.99-5.34; P = .054).
CONCLUSIONS: The velocity of prealbumin decline unmasks high-risk phenotypes of protein-energy wasting and nutritional deterioration overlooked by traditional static assessments. Integrating trajectory monitoring into routine care shifts the paradigm from treating the "value" to treating the "trend," acting as an independent associative marker for mortality in MHD patients.