Abstract
BackgroundWhile an association between hypoalbuminemia and increased risk of acute kidney injury (AKI) is well-established, the risk of AKI development and its severity among patients with elevated serum albumin is unclear. The aim of this study was to evaluate the risk of AKI in hospitalized patients stratified by various admission serum albumin levels.MethodsThis single-center retrospective study was conducted at a tertiary referral hospital. All adult hospitalized patients who had admission albumin levels available between January 2009 and December 2013 were enrolled. Admission albumin was categorized based on its distribution into six groups (≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, and ≥4.5 mg/dL). The primary outcome was the incidence of hospital-acquired AKI (HAKI). Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission albumin strata using the albumin 3.5 to 3.9 mg/dL (lowest incidence of AKI) as the reference group.ResultsOf the total 9,552 studied patients, HAKI occurred in 1,556 (16.3%) patients. The incidence of HAKI among patients with admission albumin ≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, and ≥4.5 mg/dL was 18.3%, 14.3%, 15.5%, 14.2%, 16.7%, and 26.0%, respectively. After adjusting for potential confounders, admission serum albumin levels ≤2.4 and ≥4.5 mg/dL were associated with an increased risk of HAKI with odds ratios of 1.52 (95% CI 1.18–1.94) and 2.16 (95% CI 1.74–2.69), respectively. While stage 1 HAKI was significantly more frequent among patients with admission albumin ≥4.5 mg/dL (23.0% vs. 11.6%, P<0.001), incidence of stage 3 HAKI was higher in those with albumin ≤2.4 mg/dL (2.8% vs 0.3%, P<0.001).ConclusionAdmission serum albumin levels ≤2.4 and ≥4.5 mg/dL were associated with an increased risk for HAKI. Patients with admission albumin ≥4.5 mg/dL had HAKI with a lower intensity when compared with those who had admission albumin levels ≤2.4 mg/dL.
Highlights
Acute kidney injury (AKI) is a substantial healthcare burden worldwide affecting almost 13.3 million patients per year [1, 2], associated with high morbidity and mortality, progression to chronic kidney disease (CKD), and significant healthcare costs [1,2,3,4]
After adjusting for potential confounders, admission serum albumin levels 2.4 and !4.5 mg/dL were associated with an increased risk of hospital-acquired AKI (HAKI) with odds ratios of 1.52 and 2.16, respectively
Admission serum albumin levels 2.4 and !4.5 mg/dL were associated with an increased risk for HAKI
Summary
Acute kidney injury (AKI) is a substantial healthcare burden worldwide affecting almost 13.3 million patients per year [1, 2], associated with high morbidity and mortality, progression to chronic kidney disease (CKD), and significant healthcare costs [1,2,3,4]. Studies have shown associations of hypoalbuminemia with AKI and mortality in various clinical settings including general hospitalized patients, intensive care unit (ICU), coronary bypass surgery, emergency department, and liver transplantation [14, 15, 20,21,22,23,24,25]. There are no studies that reported data on the incidence and effects of elevated serum albumin among patients admitted to the hospital. The objective of this study was to evaluate the risk of AKI in hospitalized patients stratified by various admission serum albumin levels. While an association between hypoalbuminemia and increased risk of acute kidney injury (AKI) is well-established, the risk of AKI development and its severity among patients with elevated serum albumin is unclear. The aim of this study was to evaluate the risk of AKI in hospitalized patients stratified by various admission serum albumin levels
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