Surrogate markers of higher visceral protein and muscle mass—serum creatinine and albumin levels—are associated with lower mortality among patients undergoing twice-weekly or thrice-weekly hemodialysis (HD), according to a new study.

Investigators led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine identified 1,113 twice-week HD patients and matched them by age, gender, race, diabetes, and dialysis facility region with 4,448 thrice-weekly (conventional) HD patients from a large national dialysis cohort of incident HD patients over a 5-year period (2007–2011).

Compared with conventional HD patients who concurrently had serum creatinine levels of 6 mg/dL or higher and albumin levels of 3.5 g/dL or higher, twice-weekly patients who concurrently had serum creatinine levels below 6 mg/dL and albumin levels below 3.5 g/dL had a 1.75-fold higher risk of death in a fully adjusted model, Dr. Kalantar-Zadeh and his colleagues reported online ahead of print in the Journal of Renal Nutrition. Thrice-weekly HD patients with these concurrently lower levels had a 2.2-fold increased risk of death. The investigators found no significant difference between twice-weekly and thrice-weekly HD with regard to the association between creatinine and albumin levels and mortality.

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“Our findings present an important observation regarding the role of concurrent serum creatinine and albumin when comparing mortality risk between twice-weekly versus thrice-weekly hemodialysis patients,” the investigators wrote.

Although their use of a large contemporary nationally representative incidence dialysis population was a study strength, the investigators acknowledged that they were unable to obtain sufficient data related to residual kidney function and they did not have comprehensive data that might affect HD patient outcomes, such as dialysis access type, ultrafiltration rate, and hospitalizations.

The study population had a mean age of 70 years; 48% of patients were women and 55% had diabetes mellitus. Patients with higher concurrent levels of serum creatinine and albumin tended to be younger and male, and had higher body weight, estimated lean body mass, body mass index, and serum levels of phosphorus and parathyroid hormone.

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1. Wang J et al. Concurrence of serum creatinine and albumin with lower risk for death in twice-weekly hemodialysis patients. J Ren Nutr 2016 [Epub ahead of print].