Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease

Background. Although serum albumin is a marker for malnutrition and associated with a higher mortality in adult patients with end-stage renal disease (ESRD), the risk of death associated with serum albumin is unknown in pediatric patients with ESRD. We evaluated the association between serum albumin and death among pediatric patients initiating dialysis. Methods. Data from the United States Renal Data System (USRDS) were used to identify all patients under the age of 18 who initiated dialysis between January 1. 1995 and December 31. 1998. Using the Cox proportional hazards models, the association between serum albumin obtained 45 days prior to dialysis initiation and death was estimated, controlling for demographic factors, dialysis modality, and anthropometric measures. Results. Of 1723 patients included in the analysis, there were 93 deaths over 2953 patient-years of observation. The multivariate analysis demonstrated that each -1 g/dL difference in serum albumin between patients was associated with a 54% higher risk of death [adjusted relative risk (aRR). 1.54: 95% confidence interval (CI), 1.15 to 1.85: P = 0.002]. This was independent of glomerular causes for their ESRD and other potential confounding variables. Conclusions. Pediatric patients initiating dialysis with hypo-albuminemia are at a higher risk for death. This finding persists after adjusting for glomerular causes for ESRD and other potential confounding variables. Low serum albumin at dialysis initiation is an important marker of mortality risk in pediatric ESRD patients.