Research Article: Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study

Date Published: July 19, 2017

Publisher: Public Library of Science

Author(s): Mi-yeon Yu, Sung Woo Lee, Seon Ha Baek, Ki Young Na, Dong-Wan Chae, Ho Jun Chin, Sejoong Kim, Emmanuel A. Burdmann.


Development of acute kidney injury (AKI) is common and is associated with poor outcomes. We aimed to determine whether hypoalbuminemia (HA) at admission could be a risk factor for the development of AKI and mortality in hospitalized patients.

We enrolled patients who were admitted to Seoul National University Bundang Hospital from January 2013 to December 2013. HA at admission was defined as a serum albumin level < 3.4 mg/dL measured within two days after admission. AKI was defined as an increase in the serum creatinine level by ≥0.3 mg/dL or ≥1.5 times of the baseline value during the hospital stay. A total of 19,472 patients were enrolled and divided into HA and normoalbuminemia (NA) groups at admission. The incidence of AKI was 10.7% (340/3179) in the HA group and 4.1% (662/16293) in the NA group (adjusted odds ratio [OR], 1.243; 95% confidence interval [CI], 1.069–1.445; P = 0.005). The hazard ratios for the 30-day, 90-day, and 1-year mortality were 1.873 (95% CI, 1.383–2.537; P < 0.001), 1.710 (95% CI, 1.410–2.072; P < 0.001), and 1.372 (95% CI, 1.214–1.551; P < 0.001), compared to the NA group. In patients with AKI, albumin replacement improved renal recovery (OR, 2.605; 95% CI, 1.450–4.681; P = 0.001). The mortality rate was not different according to albumin replacement. HA is associated with the development of AKI and high mortality in hospitalized patients. Replacement of albumin after the development of AKI may contribute to renal recovery. Further clinical trials are warranted.

Partial Text

Acute kidney injury (AKI) has an incidence rate of 22% among hospitalized patients worldwide [1]. AKI is known to be associated with mortality, as reported in a recent meta-analysis [2]. As the incidence of AKI increases [3], the need for prevention and treatment of hospital-acquired AKI has been increasing. Many studies have attempted to identify the risk factors of AKI and have shown that age, sex, race, baseline renal function, and underlying diseases are related to the development of AKI [4, 5].

Fig 1 shows the algorithm for the eligible patient selection. A total of 19,472 patients were enrolled and divided into two groups according to the serum albumin concentration. The number of patients with NA was 16,293 (83.7%), and that of patients with HA was 3,179 (16.3%). Of the total enrolled patients, 1,002 (5.1%) developed AKI, of whom 259 (23.9%) received albumin within 2 days after the occurrence of AKI. The median duration between hospital admission and AKI diagnosis was 4 days (interquartile range, 3–10).

In our large cohort study of admitted patients, pre-existing HA not only affected AKI development and patients’ long-term survival, but also synergized the mortality in the presence of AKI. In addition, albumin replacement in the patients with AKI was strongly associated with AKI recovery but not with the patients’ survival.




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