Association of serum prealbumin and its changes over time with clinical outcomes and survival in patients receiving hemodialysis

Background: In patients receiving maintenance hemodialysis(MHD), a low serum prealbumin is an indicator of protein-energy wasting. Objective: We hypothesized that baseline serum prealbumin correlates independently with health-related quality of life (QoL) and death and that its change over time is a robust mortality predictor. Design: Associations and survival predictability of serum prealbumin at baseline and its changes over 6 mo were examined in a 5-y (2001-2006) cohort of 798 patients receiving MHD. Results: Patients with serum prealbumin >= 40 mg/dL had greater mid-arm muscle circumference but lower percentage of total body fat. Both serum interleukin-6 and dietary protein intake correlated independently with serum prealbumin. Measures of QoL indicated better physical health, physical function, and functionality with higher prealbumin concentrations. Although baseline prealbumin was not superior to albumin in predicting survival, in both all and normoalbuminemic (albumin >= 3.5 g/dL; n = 655) patients, prealbumin < 20 mg/dL was associated with higher death risk in adjusted models, but further adjustments for inflammatory cytokines mitigated the associations. In 412 patients with baseline prealbumin between 20 and 40 mg/dL whose serum prealbumin was remeasured after 6 mo, a >= 10-mg/dL fall resulted in a death hazard ratio of 1.37 (95% CI: 1.02, 1.85; P = 0.03) after adjustment for baseline measures, including inflammatory markers. Conclusions: Even though baseline serum prealbumin may not be superior to albumin in predicting mortality in MHD patients, prealbumin concentrations < 20 mg/dL are associated with death risk even in normoalbuminemic patients, and a fall in serum prealbumin over 6 mo is independently associated with increased death risk. Am J Clin Nutr 2008; 88: 1485-94.