U-Shaped Association between Serum Albumin and Development of Chronic Kidney Disease in General Hypertensive Patients

Abstract

Objective: We aimed to examine the association between serum albumin (SAlb) and the development of chronic kidney disease (CKD), and examine any possible effect modifiers in general hypertensive patients with normal renal function and with no previous cardiovascular diseases (CVD). Methods: This is a post-hoc analysis of 12,621 hypertensive adults with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73 m2 and SAlb ≥35.0g/L from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT). The primary outcome was development of CKD, defined as a decrease in eGFR of ≥30% and to a level of <60mL/min/1.73m2; or end stage renal disease. Results: The median follow-up duration was 4.4 years. Overall, the association between SAlb levels and risk of the primary outcome followed a U-shape. The risk of CKD development significantly decreased with the increment of Salb (per g/L: OR= 0.92; 95%CI: 0.88-0.96) in participants with SAlb 0.05). Conclusions: There was a U-shaped association between SAlb levels and risk of CKD development among general hypertensive patients with normal renal function and without CVD, with a turning point at about 51.4g/L. Funding: This work was supported by Projects of the National Key Research and Development Program [2016YFC0903101, 2016YFC0904900, 2016YFE0205400]; the National Natural Science Foundation of China [81473052, 81402735, 81670669]; the Science and Technology Planning Project of Guangzhou, China [201707020010]; the Science, Technology and Innovation Committee of Shenzhen [KQCX20120816105958775, JSGG20160229173428526, JSGG20170412155639040, GJHS20170314114526143, KC2014JSCX0071A]; President Foundation of Nanfang Hospital, Southern Medical University [2017C007]; Outstanding Youths Development Scheme of Nanfang 339 Hospital, Southern Medical University [2017J009]. Declaration of Interest: Dr. Xiping Xu reports grants from the Projects of the National Natural Science Foundation of China; the Science and Technology Project of Guangdong Province; the Science and Technology Planning Project of Guangzhou, China; and the Science, Technology and Innovation Committee of Shenzhen. Dr. Xianhui Qin reports grants from the Projects of the National Science Foundation. Dr. Guobao Wang reports grants from the Projects of the National Science Foundation. Dr. Binyan Wang reports grants from the National Key Research and Development Program. Dr. Yong Huo reports grants from the National Key Research and Development Program and nonfinancial support from Shenzhen AUSA.No other disclosures were reported. Ethical Approval: The study was approved by the Ethics Committee of the Institute of Biomedicine, Anhui Medical University, Hefei, China (FWA assurance number: FW1263).