TY - JOUR
T1 - Hypoalbuminemia is associated with increased risk of acute kidney injury in hospitalized patients
T2 - A meta-analysis
AU - Hansrivijit, Panupong
AU - Yarlagadda, Keerthi
AU - Cheungpasitporn, Wisit
AU - Thongprayoon, Charat
AU - Ghahramani, Nasrollah
N1 - Funding Information:
Our meta-analysis showed that each 1.0 g/dL decrement of serum albumin level was associated with increased death from AKI. Unlike the findings from Wiedermann et al. [14], we found that association between hypoalbuminemia and mortality in AKI patients was subjected to publication bias. Adaptation to clinical practice should be cautiously considered. All citations included in Wiedermann et al. were present in our meta-analysis. Clinical trials are required to conclude the risk prediction of serum albumin levels and mortality from AKI. The outcomes of albumin infusion in spontaneous bacterial peritonitis among cirrhotic patients were reported by Roux et al. [19]. In this study, the authors state that the recommendations for albumin infusion during spontaneous bacterial peritonitis would be challenged in a clinical trial using a much cheaper alternative, such as normal saline. This trial will be sponsored by the French Ministry of Health. Our subgroup analyses also showed that younger patients (< 70 years) and baseline serum creatinine levels ≥2.0 mg/dL had significantly higher risk of death from AKI. Acute kidney injury that occurred in hospitalized patients was associated with a 4-fold increased risk of death [20]. Younger patients may have higher risk of death from AKI for at least two reasons. First, although young patients have greater renal reserve, it can also be interpreted that most renal reserve must be lost for AKI to develop. Second, the etiology of AKI in younger patients may be more severe and less reversible than in older patients. Moreover, note that prospective studies, prior to 2015, conducted in non-Asian countries, low sample size (< 500) are significant risk factors for increased AKI mortality. This implied that newer studies tend to report a positive correlation between hypoalbuminemia and AKI mortality. When excluded these studies, lower limit of 95% CI was close to 1.0 – making it premature to draw an association between hypoalbuminemia and increased risk of death from AKI.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jcrc.2020.10.013
DO - 10.1016/j.jcrc.2020.10.013
M3 - Article
C2 - 33157311
AN - SCOPUS:85094944072
SN - 0883-9441
VL - 61
SP - 96
EP - 102
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -