Hypoalbuminemia is associated with increased risk of acute kidney injury in hospitalized patients: A meta-analysis

Purposes: Previous systematic review suggested that hypoalbuminemia is associated with increased risk of acute kidney injury (AKI). However, pooled sample size was small, and there was no universal definition for AKI. Materials and methods: vid MEDLINE, EMBASE, the Cochrane Library and Database of Abstracts of Reviews of Effects (DARE) were search up to December 2019. Inclusion criteria include: observational studies, age ≥ 18 years, non-end-stage kidney disease, AKI, or mortality are outcomes of interest. Only articles utilizing multivariate analysis were included. Results: A total of 39 studies were included in hypoalbuminemia and AKI cohort (n = 168,740), and 15 studies were included in mortality cohort (n = 5693). Each 1.0 g/dL decrement of serum albumin was associated with increased AKI (OR 1.685; 95% CI, 1.302–2.179). The risk remained significant across sensitivity analyses. Furthermore, subgroup analyses showed that age ≥ 70 years and baseline serum albumin level > 3.2 g/dL were significant risk factors for AKI. In mortality cohort, patients with AKI and hypoalbuminemia had significantly higher death (OR 1.183; 95% CI, 1.085–1.288). However, there was potential publication bias to this analysis. Conclusions: Hypoalbuminemia is associated with AKI in hospitalized patients. However, the effect on mortality is subjected to publication bias.