Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies
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SYSTEMATIC REVIEW
Christian J. Wiedermann Wolfgang Wiedermann Michael Joannidis
Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies
Received: 14 December 2009 Accepted: 3 May 2010 Published online: 2 June 2010 Ó Copyright jointly held by Springer and ESICM 2010
Abstract Purpose: To test the hypothesis that hypoalbuminemia is independently associated with increased risk of acute kidney injury (AKI). Methods: A meta-analysis was performed of observational clinical studies evaluating the relationship between serum albumin level and the occurrence of AKI by multivariate methods. Additionally, the impact was assessed of lower serum albumin on mortality in patients who developed AKI. Eligible studies were sought by multiple methods, and adjusted odds ratios (OR) were quantitatively combined using a random effects model. Results: Seventeen clinical studies with 3,917 total patients were included: 11 studies (6 in surgical or intensive care unit patients and 5 in other hospital settings) evaluating the influence of serum albumin on AKI incidence and 6 studies describing the relationship between serum albumin and mortality among patients who had developed AKI. Lower serum albumin was an independent predictor
C. J. Wiedermann ()) Division of Internal Medicine, Central Hospital of Bolzano, Lorenz Bo¨hler Street 5, 39100 Bolzano, Italy e-mail: [email protected] Tel.: ?39-471-908190 Fax: ?39-471-908303 W. Wiedermann Division of Applied Psychology and Research Methodology, Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria M. Joannidis Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
Introduction Acute kidney injury (AKI) is associated with significant morbidity and mortality in critically ill patients [1, 2]. Risk factors leading to this complication are under active investigation [3]. Among independent risk factors for AKI currently identified are age, body mass index, baseline renal function, acute circulatory or respiratory failure,
both of AKI and of death after AKI development. With each 10 g L-1 serum albumin decrement, the odds of AKI increased by 134%. The pooled OR for AKI was 2.34 with a 95% confidence interval (CI) of 1.74– 3.14. Among patients who had developed AKI, the odds of death rose 147% (pooled OR 2.47, 95% CI 1.51–4.05) with each 10 g L-1 serum albumin decrement. Conclusions: This meta-analysis provides evidence that hypoalbuminemia is a significant independent predictor both of AKI and of death following AKI development. Serum albumin determinations may be of utility in identifying patients at increased risk for AKI or for death after AKI. Controlled studies are warranted to assess interventions aimed at correcting hypoalbuminemia. Keywords Hypoalbuminemia Serum albumin Acute kidney injury Mortality Risk factors Meta-analysis
liver disease, infection, peripheral vascular occlusive disease, chronic obstructive pulmonary disease, chronic heart failure, lymphoma or leukemia, prior invasiv
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