Baseline Serum Albumin for Long-Term Risk Stratification in Maintenance Hemodialysis Patients - A Retrospective Cohort Study

Q: What was the main objective of the study?

To evaluate the association between baseline serum albumin levels and up to 10-year all-cause mortality in adults receiving maintenance hemodialysis.

Q: How were patients grouped for analysis?

Patients were categorized into two groups based on baseline serum albumin: <3.5 g/dL and ≥3.5 g/dL.

Q: What did the results show about serum albumin and mortality?

Lower albumin (<3.5 g/dL) was associated with significantly higher long-term mortality and remained an independent predictor in multivariate analysis (HR 1.84, p < 0.001).

Q: Is serum albumin considered causal in the study?

The findings indicate albumin is not a causal determinant; its association with survival likely reflects underlying nutritional and inflammatory burden, and prospective multicenter validation is recommended.

Sep 30, 2026

Upload by kopisore

Mortality among maintenance hemodialysis patients remains high, and reliable biomarkers for early long-term risk stratification are needed. This retrospective cohort study assessed how baseline serum albumin relates to all-cause mortality over up to 10 years, using adult patients on maintenance hemodialysis from 2015–2025. Patients were grouped by albumin <3.5 g/dL versus ≥3.5 g/dL, with survival evaluated by Kaplan–Meier and mortality predictors by Cox regression; albumin <3.5 g/dL independently predicted higher mortality and adverse clinical outcomes.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Article Baseline Serum Albumin for Long-Term Risk Stratification in Maintenance Hemodialysis Patients: A Retrospective Cohort Study Kür¸sad Öneç *, Gül¸sah Altun and Tansu Sav Academic Editor: Peter Schnuelle Received: 15 December 2025 Revised: 29 December 2025 Accepted: 30 December 2025 Published: 1 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Department of Nephrology, Faculty of Medicine, Duzce University, Duzce 81620, Türkiye; [gulsahaltuntas11@gmail.com](gulsahaltuntas11@gmail.com) (G.A.); [savtansu@gmail.com](savtansu@gmail.com) (T.S.) * Correspondence: [kursadonec@gmail.com](kursadonec@gmail.com) Abstract Background/Objectives: Mortality among patients receiving maintenance hemodialysis remains high, and biomarkers that allow early risk stratification are needed. Serum albumin reflects nutritional status and systemic inflammation and has been associated with adverse outcomes; however, its long-term prognostic significance remains incompletely defined. This study examined the association between baseline serum albumin and long-term (up to 10-year) all-cause mortality in a large hemodialysis cohort. Methods: This retrospective cohort study included adult patients undergoing maintenance hemodialysis between 2015 and 2025 at a tertiary nephrology center. Individuals with at least three months of stable dialysis and available baseline serum albumin measurements were included. Patients were categorized into two groups according to baseline serum albumin levels (<3.5 g/dL and ≥3.5 g/dL). The primary outcome was long-term (up to 10-year) all-cause mortality, while secondary outcomes included emergency department visits, hospital admissions, cardiovascular events, and infection-related hospitalizations. Survival was assessed using Kaplan–Meier analysis, and predictors of mortality were evaluated using Cox proportional hazards regression. The median follow-up duration was 54 months (interquartile range: 28–92), with a maximum follow-up of 10 years. Results: A total of 412 patients were analyzed, of whom 40.8% had serum albumin levels < 3.5 g/dL. During follow-up, 233 deaths occurred. Lower albumin levels were associated with significantly higher mortality (76.2% vs. 43.4%, p < 0.001), increased healthcare utilization, and a greater incidence of cardiovascular and infectious complications. In multivariate analysis, albumin < 3.5 g/dL remained an independent predictor of mortality (hazard ratio 1.84, 95% confidence interval 1.42–2.38; p < 0.001) . Receiver operating characteristic analysis identified 3.4 g/dL as the optimal cutoff for mortality prediction (area under the curve 0.72) . Conclusions: Baseline serum albumin is an independent predictor of long-term (up to 10-year) mortality and adverse clinical outcomes in patients receiving maintenance hemodialysis. Although albumin is not a causal determinant, its association with survival likely reflects underlying nutritional and inflammatory burden. Prospective multicenter studies are warranted to validate albumin-based risk stratification and to evaluate the prognostic value of longitudinal changes in serum albumin over time. Keywords: hemodialysis; albumin; mortality; prognosis; inflammation; risk stratification 1. Introduction End-stage kidney disease requiring maintenance hemodialysis remains a major global health burden, with affected patients experiencing markedly reduced survival compared with the general population. Despite advances in dialysis technology, vascular access care, and infection control, long-term mortality rates in this population remain unacceptably high [1–3] . Identifying simple, reliable, and widely accessible biomarkers that can predict survival is therefore a key priority in nephrology as such indicators may facilitate early risk stratification and guide

FAQs

What was the main objective of the study?

To evaluate the association between baseline serum albumin levels and up to 10-year all-cause mortality in adults receiving maintenance hemodialysis.

How were patients grouped for analysis?

Patients were categorized into two groups based on baseline serum albumin: <3.5 g/dL and ≥3.5 g/dL.

What did the results show about serum albumin and mortality?

Lower albumin (<3.5 g/dL) was associated with significantly higher long-term mortality and remained an independent predictor in multivariate analysis (HR 1.84, p < 0.001).

Is serum albumin considered causal in the study?

The findings indicate albumin is not a causal determinant; its association with survival likely reflects underlying nutritional and inflammatory burden, and prospective multicenter validation is recommended.

Sep 30, 2026

Upload by kopisore