Dataset Information

Albumin to Total Cholesterol Ratio and Mortality in Peritoneal Dialysis.

ABSTRACT:

Background

Serum albumin and total cholesterol are associated with mortality. In clinical practice, evaluating the association of combining album and total cholesterol with mortality may be more reasonable. Thus, we examined the association between serum albumin to total cholesterol ratio and mortality in peritoneal dialysis (PD) patients.

Methods

We conducted a retrospective cohort study of 3447 incident continuous ambulatory peritoneal dialysis (CAPD) patients from five PD centers in China from 1 January 2005 and 31 May 2020. The association between albumin to total cholesterol ratio and mortality was evaluated.

Results

With a median follow-up of 39.3 months, 762 (22.1%) all-cause deaths occurred, including 382 (11.1%) cardiovascular deaths. As compared with a serum albumin to total cholesterol ratio of 0.77-0.82 (reference range), a higher ratio (>0.82) was associated with increased risks of all-cause mortality[hazards ratio (HR), 1.54; 95% confidence interval (CI), 1.16-2.05, E-value = 2.45] and cardiovascular mortality (HR, 2.10; 95% CI, 1.35-3.29, E-value = 3.62). A lower ratio (<0.77) was also associated with increased risks of all-cause mortality (HR, 1.46; 95% CI, 1.10-1.94, E-value = 2.28) and cardiovascular mortality (HR, 1.78; 95% CI, 1.14-2.78, E-value = 2.96) compared with the reference. No interaction was observed in subgroup analyses of age, sex, diabetes mellitus, hypertension, prior cardiovascular disease, and hyperlipidemia, and malnutrition (serum albumin <3.6 g/dL).

Conclusion

An albumin to total cholesterol ratio before the start of PD between 0.77 and 0.82 was associated with a lower risk of death than a higher or lower ratio, resulting in a U-curve association. Therefore, serum albumin to total cholesterol ratio, as an inexpensive and readily available biochemical biomarker, may further improve the stratification risk of mortality in PD patients.

SUBMITTER: Wu X

PROVIDER: S-EPMC9218528 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Albumin to Total Cholesterol Ratio and Mortality in Peritoneal Dialysis.

Wu Xianfeng X Meng Jiao J Zhou Lei L Zhan Xiaojiang X Wen Yueqiang Y Wang Xiaoyang X Feng Xiaoran X Wang Niansong N Peng Fenfen F Wu Junnan J

Frontiers in medicine 20220609

<h4>Background</h4>Serum albumin and total cholesterol are associated with mortality. In clinical practice, evaluating the association of combining album and total cholesterol with mortality may be more reasonable. Thus, we examined the association between serum albumin to total cholesterol ratio and mortality in peritoneal dialysis (PD) patients.<h4>Methods</h4>We conducted a retrospective cohort study of 3447 incident continuous ambulatory peritoneal dialysis (CAPD) patients from five PD cente ...[more]

PMID: 35755025

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Project description:Objectives:The monocyte-to-lymphocyte ratio (MLR), as a new marker of the systemic inflammatory response, is associated with cardiovascular disease (CVD) mortality in the general population and hemodialysis patients. However, the association between the MLR and CVD mortality in peritoneal dialysis (PD) has received little attention. Methods:In this multicenter retrospective cohort study, 1753 incident PD patients from November 1, 2005, to June 30, 2017, with a baseline MLR were enrolled. The primary endpoint was CVD mortality. The association of MLR with CVD mortality was assessed using a multivariable-adjusted Cox model and the Fine and Gray competing risk model. Results:Of 1753 patients, the mean age was 51.1 ± 14.9 years, 56.9% of patients were male, and the Charlson comorbidity index was 4.29 ± 1.75. During the follow-up period of 31.2 ± 18.4 months, 368 patients died, of which 200 (54.3%) deaths were caused by CVD events. CVD mortality rates for the lowest, middle, and highest MLR tertiles were 70.6, 78.4, and 88.9 per 1000 patient-years, respectively (P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log?rank = 22.41, P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log?rank = 22.41, P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log?rank = 22.41, P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log?rank = 22.41, P < 0.001). After adjusting for confounding factors, the highest MLR tertile was significantly associated with a hazard ratio (HR) for CVD mortality of 1.45 (95% confidence interval, 1.13-2.51, P = 0.016). The Fine and Gray method analysis showed that using all-cause mortality as competing risk, the highest MLR tertile remained an independent predictor of CVD mortality (HR = 1.39, 95% CI 1.10-2.47, P = 0.021). Conclusions:Higher MLR levels at the commencement of PD may be independently associated with increased CVD mortality in PD patients.

Project description:Serum albumin level predicts mortality in dialysis patients and is used to assess their health status and the quality of delivered care. Whether the threshold level of serum albumin at which mortality risk increases in peritoneal dialysis (PD) patients is the same as for hemodialysis (HD) patients has not been studied.Observational cohort study of dialysis patients undertaken to determine the survival-predictability of serum albumin level in PD patients and compare it with that in HD patients.130,052 dialysis patients (PD, 12,171; HD, 117,851) who received treatment in any of the 580 dialysis units owned by DaVita Inc between July 1, 2001, through June 30, 2006, followed up through June 30, 2007.Baseline and time-averaged serum albumin level (assayed using bromcresol green) and change in serum albumin level over 6 months.All-cause, cardiovascular, and infection-related mortality.PD patients with baseline serum albumin level <3.0 g/dL had a more than 3-fold higher adjusted risk of all-cause and cardiovascular mortality and 3.4-fold higher risk of infection-related mortality (reference group: serum albumin, 4.00-4.19 g/dL). Adjusted all-cause mortality was significantly lower in PD patients with a ?0.3-g/dL increase in serum albumin level over 6 months and significantly higher in those for whom it decreased by ?0.2 g/dL (reference group: serum albumin change, +0.1 to -0.1 g/dL). A significant increase in death risk was evident for HD patients with serum albumin level <4.0 g/dL, but at <3.8 g/dL for PD patients. For each albumin category, overall death risk for PD patients was lower than for HD patients (reference group: HD patients with serum albumin of 4.00-4.19 g/dL).Study can identify associations only without attribution of causality and residual confounding cannot be excluded.Serum albumin predicts all-cause, cardiovascular, and infection-related mortality in both PD and HD patients. However, the threshold at which risk of death increases varies by dialysis modality, and this difference should be considered by agencies or organizations that set quality standards.

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Dataset Information

Albumin to Total Cholesterol Ratio and Mortality in Peritoneal Dialysis.

Background

Methods

Results

Conclusion

Publications

Albumin to Total Cholesterol Ratio and Mortality in Peritoneal Dialysis.

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