Association of prealbumin level with mortality in patients with acute kidney injury

Abstract

Acute kidney injury (AKI) is common in hospitalized patients, a population with a high prevalence of malnutrition. Pre-existing malnutrition is associated with adverse outcomes in patients with AKI. This Practice Point commentary discusses a study by Perez Valdevieso et al. that examined the association between serum prealbumin level and mortality in patients with AKI. Adjusted multivariate analyses showed that a serum prealbumin level below the group median (11 mg/dl) was independently predictive of in-hospital mortality and that for every 5 mg/dl increase in serum prealbumin level, in-hospital mortality decreased by 29%. A decreased serum prealbumin concentration at the time of renal consultation for AKI independently predicted poor prognosis. It is unknown whether this adverse prognostic association is primarily caused by malnutrition, a negative acute phase response to inflammation, transcapillary leak, or a combination of factors. Serum prealbumin levels may aid prognostic stratification and clinical decision making in AKI and should be included in future studies. There is no evidence that attempting to raise low prealbumin levels through aggressive nutritional support improves outcomes in AKI.