Albumin to Total Cholesterol Ratio and Mortality in Peritoneal Dialysis

Xianfeng Wu; Jiao Meng; Lei Zhou; Xiaojiang Zhan; Yueqiang Wen; Xiaoyang Wang; Xiaoran Feng; Niansong Wang; Fenfen Peng; Junnan Wu

doi:10.3389/fmed.2022.896443

Albumin to Total Cholesterol Ratio and Mortality in Peritoneal Dialysis

Front Med (Lausanne). 2022 Jun 9:9:896443. doi: 10.3389/fmed.2022.896443. eCollection 2022.

Authors

Xianfeng Wu^{1

2}, Jiao Meng³, Lei Zhou⁴, Xiaojiang Zhan⁵, Yueqiang Wen⁶, Xiaoyang Wang⁷, Xiaoran Feng⁸, Niansong Wang^{1

2}, Fenfen Peng⁹, Junnan Wu³

Affiliations

¹ Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
² Clinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
³ Department of Nephrology, Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital, Hangzhou, China.
⁴ Evergreen Tree Nephrology Association, Guangzhou, China.
⁵ Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁶ Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁷ Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁸ Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China.
⁹ Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.

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.

Keywords: albumin to total cholesterol ratio; cardiovascular; mortality; peritoneal dialysis; prognosis.