Prevalence and Predictive Value of Hypoalbuminemia in Appalachians With Chronic Kidney Disease

Rebecca J. Schmidt, Bethany Pellegrino, Karen MacKay, Tony Parravani, Raza Mustafa, Gerry Hobbs


Background: Chronic kidney disease (CKD) has reached epidemic proportions worldwide and in the United States, racial minorities reach end stage renal disease (ESRD) at a disproportionate rate. A rural state in the heart of Appalachia, West Virginia leads the nation in rates of incident ESRD, despite its predominantly Caucasian population. Characteristics of this racially homogeneous CKD population are herein examined for their impact on progression to ESRD or death.

Methods: Retrospective analysis of demographic and clinical information for 4258 patients seen between 2001 and 2010. Associations between risk factors and outcomes were assessed for significance using Cox Proportional Hazards models.

Results: Patients with CKD were largely Caucasian (94.3%), 39% diabetic, with a mean age of 60.1 16.7; 39% presented with serum albumin levels <= 3.5 g/dl. Patients with higher albumin levels had better survival and less progression to dialysis than those with lower levels (P < 0.0001). Hypoalbuminemia, hypocalcemia, hyperparathyroidism and anemia independently correlated with reduced survival and more rapid progression to ESRD (P < 0.0001). Compared to those from more affluent counties, patients from poorer counties had lower albumin levels (3.36 0.014 vs 3.68 0.079 gm/dl; P < 0.04) and higher rates of progression to dialysis or death (P < 0.016).

Conclusions: In this predominantly Caucasian population of central Appalachia, hypoalbuminemia and residence in a county of low socioeconomic status independently predicted overall survival and progression to dialysis, suggesting that poverty and culture, irrespective of race, warrant further study for their impact on outcomes in patients with CKD.



Albumin; Chronic kidney disease; Hypoalbuminemia; Socioeconomics; Survival

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