A Low Serum Albumin Level Predicts Cardiovascular Events in Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Mizuki Komatsu,Ken Tsuchiya,Hiroshi Kawaguchi,Masayuki Okazaki,Kosaku Nitta

doi:10.4236/ijcm.2015.62013

Abstract

Background: Cardiovascular (CV) diseases are the most frequent cause of death in hemodialysis (HD) patients. The aim of this study was to identify risk factors for CV events in HD patients with preserved left ventricular ejection fraction (PEF). Objectives: A total of 213 HD patients (69 years, 64.1% males) were enrolled. Demographic, laboratory test, and echocardiographic data were recorded, and CV events during the 32-month follow-up period were documented. Results: During the follow-up period, 31 patients (14.6%) died and 50 patients (23.5%) suffered a fatal or nonfatal CV event. Age and serum albumin, C-reactive protein, total cholesterol, non-HDL cholesterol, and NT-proBNP levels were associated with CV events according to a univariate analyses. A multivariate analysis identified a low serum albumin value (p < 0.001) as an independent predictor of CV events. A low serum albumin level was also identified as an independent predictor of all-cause mortality (p = 0.0356). Kaplan-Meier curves showed CV events to be more frequent in the group of subjects with the lowest tertile of serum albumin levels (p = 0.0063). Conclusion: A low serum albumin value is an important risk factor for death and CV events in HD patients with PEF.

Highlights

The high mortality of patients with end-stage renal disease (ESRD) is mainly attributable to cardiovascular (CV) diseases, which are responsible for more than 40% of the deaths in this patient population [1] [2]
Systolic function may be estimated by echocardiography on the basis of the left ventricular ejection fraction (LVEF) or fractional shortening, which is the index that has been used in the great majority of studies [4]
The results of the present study show that a low serum albumin levels is the best long-term independent predictor of mortality in HD patients with preserved left ventricular ejection fraction (PEF), and they identified a low serum albumin level as an independent risk factor for developing CV events

Summary

Introduction

The high mortality of patients with end-stage renal disease (ESRD) is mainly attributable to cardiovascular (CV) diseases, which are responsible for more than 40% of the deaths in this patient population [1] [2]. Numerous reports have suggested that more than half of patients with congestive heart failure do not have any abnormality of systolic function Such patients may have heart failure on the basis of diastolic dysfunction despite having preserved LVEF (PEF) [5] [6]. The aim of this study was to identify risk factors for CV events in HD patients with preserved left ventricular ejection fraction (PEF). A multivariate analysis identified a low serum albumin value (p < 0.001) as an independent predictor of CV events. A low serum albumin level was identified as an independent predictor of all-cause mortality (p = 0.0356). Conclusion: A low serum albumin value is an important risk factor for death and CV events in HD patients with PEF

Objectives

Methods

Results

Conclusion