Abstract
BackgroundSeveral epidemiological studies have demonstrated associations between variability in a number of biological parameters and adverse outcomes. As the variability may reflect impaired homeostatic regulation, we assessed albumin variability over time in chronic hemodialysis (HD) patients.MethodsData from 1346 subjects who received chronic HD treatment from May 2001 to February 2015 were analyzed according to three phases of HD treatment: post-HD initiation, during maintenance HD treatment, and before death. The serum albumin values were grouped according to the time interval from HD initiation or death, and the yearly trends for both the albumin levels and the intra-individual albumin variability (quantified by the residual coefficient of variation: Alb-rCV) were examined. The HD initiation and death-associated changes were also analyzed using generalized additive mixed models. Furthermore, the long-term trend throughout the maintenance treatment period was evaluated separately using linear regression models.ResultsAlbumin levels and variability showed distinctive changes during each of the 3 periods. After HD initiation, albumin variability decreased and reached a nadir within a year. During the subsequent maintenance treatment period (interquartile range = 5.2–11.0 years), the log Alb-rCV showed a significant upward trend (mean slope: 0.011 ± 0.035 /year), and its overall mean was -1.49 ± 0.08 (equivalent to an Alb-rCV of 3.22%). During the 1–2 years before death, this upward trend clearly accelerated, and the mean log Alb-rCV in the last year of life was -1.36 ± 0.17. The albumin levels and variability were negatively correlated with each other and exhibited exactly opposite movements throughout the course of chronic HD treatment. Different from the albumin levels, albumin variability was not dependent on chronological age but was independently associated with an individual’s aging and death process.ConclusionThe observed upward trend in albumin variability seems to be consistent with a presumed aging-related decline in homeostatic capacity.
Highlights
Several observational studies on blood pressure, blood glucose, and blood hemoglobin have shown associations between a high variability in these parameters and an adverse outcome [1,2,3,4,5,6]
We recently examined the variability of these and other parameters in routine blood examinations of hemodialysis (HD) patients and found that such associations are not limited to only a few parameters
For patients with chronic kidney disease (CKD), the variability of hemoglobin and blood pressure has been reported to increase according to the CKD stage [12,13,14]
Summary
Several observational studies on blood pressure, blood glucose, and blood hemoglobin have shown associations between a high variability in these parameters and an adverse outcome [1,2,3,4,5,6]. For patients with chronic kidney disease (CKD), the variability of hemoglobin and blood pressure has been reported to increase according to the CKD stage [12,13,14]. These observations in general indicate that variability is related to an unhealthy status. Similar to the extent of variability, the prevalence of frailty is known to be high in populations with chronic diseases, advanced CKD [17,18] Considering these facts, a diminished homeostatic control is likely reflected by an elevated variability of some biological parameters. As the variability may reflect impaired homeostatic regulation, we assessed albumin variability over time in chronic hemodialysis (HD) patients
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