World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Original Article

Volume 1, Number 1, February 2012, pages 8-15

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

Figure 1. Incidence of ESRD (persons per million population) from 1980 to 2007 for West Virginia, Network 5 and the US [2].

Figure 3. Plot survival quantiles for blood parameters at presentation and time to death or start of dialysis. Curves are fitted 10th, 50th and 90th percentiles as a function of calcium, hemoglobin, intact PTH, albumin and economic index.

**Table 1.** Demographic Data for West Virginia CKD Patients
	Stage	All
*Patients with eGFRs.
	1	2	3	4	5
Number of patients*	313	690	1767	972	516	4258*
Diagnosis of diabetes (%)	71 (23%)	210 (30%)	733 (41%)	428 (44%)	235 (46%)	1677 (39%)
Caucasian (%)	89%	94%	95%	96%	92%	94.3%
Female (%)	58%	50%	51%	55%	52%	52%
Age (mean ± SD)	38.88 ± 15.65	51.28 ± 15.93	63.70 ± 14.22	66.21 ± 14.19	60.81 ± 15.51	60.1 ± 16.7
Age > 65 (%)	6%	21%	51%	60%	45%	44%
eGFR (ml/min), (mean ± SD)	110.67 ± 22.4	72.96 ± 8.59	43.27 ± 8.45	22.75 ± 4.26	10.03 ± 2.96

Table 1. Demographic Data for West Virginia CKD Patients

Stage

All

*Patients with eGFRs.

Number of patients*

313

690

1767

972

516

4258*

Diagnosis of diabetes (%)

71 (23%)

210 (30%)

733 (41%)

428 (44%)

235 (46%)

1677 (39%)

Caucasian (%)

89%

94%

95%

96%

92%

94.3%

Female (%)

58%

50%

51%

55%

52%

Age (mean ± SD)

38.88 ± 15.65

51.28 ± 15.93

63.70 ± 14.22

66.21 ± 14.19

60.81 ± 15.51

60.1 ± 16.7

Age > 65 (%)

21%

51%

60%

45%

44%

eGFR (ml/min), (mean ± SD)

110.67 ± 22.4

72.96 ± 8.59

43.27 ± 8.45

22.75 ± 4.26

10.03 ± 2.96

**Table 2.** Clinical Data for West Virginia CKD Patients
Stage	Mean first Hgb	SD	Mean first PTH	SD	Mean first calcium	SD	Mean first albumin	SD	% ≤ 3.5 gm/dl
1	13.78	1.91	67.14	41.80	9.30	1.21	3.58	0.67	39%
2	13.49	1.70	80.94	116.62	9.22	0.63	3.71	0.61	28%
3	12.90	1.78	94.68	84.93	9.25	0.69	3.67	0.57	33%
4	12.12	1.83	137.01	115.98	9.05	0.77	3.49	0.66	45%
5	11.78	1.74	261.86	310.55	8.73	0.95	3.21	0.70	62%
All	12.82	1.79	128.33	133.98	9.11	0.85	3.58	0.63	39%

Table 2. Clinical Data for West Virginia CKD Patients

Stage

Mean first Hgb

Mean first PTH

Mean first calcium

Mean first albumin

% ≤ 3.5 gm/dl

13.78

1.91

67.14

41.80

9.30

1.21

3.58

0.67

39%

13.49

1.70

80.94

116.62

9.22

0.63

3.71

0.61

28%

12.90

1.78

94.68

84.93

9.25

0.69

3.67

0.57

33%

12.12

1.83

137.01

115.98

9.05

0.77

3.49

0.66

45%

11.78

1.74

261.86

310.55

8.73

0.95

3.21

0.70

62%

All

12.82

1.79

128.33

133.98

9.11

0.85

3.58

0.63

39%

**Table 3.** Albumin Levels of West Virginia Patients vs. NHANES Dataset [9] and a Large Urban Public Health System [9]
Stage	WV CKD (mean ± SE)	NHANES CKD (mean ± SE)	WV CKD (mean ± SD)	Urban Public Health System (mean ± SD)
P < 0.0001 except where *P = 0.001; †P = 0.16; ‡ = NS.
3a	3.67 ± 0.02	4.2 ± 0.01	3.67 ± 0.58	4.0 ± 0.6
3b	3.67 ± 0.02	4.1 ± 0.02	3.67 ± 0.57‡	3.7 ± 0.8‡
4	3.49 ± 0.02	4 ± 0.04	3.49 ± 0.66†	3.4 ± 0.8†
5	3.21 ± 0.04	4.1 ± 0.16	3.21 ± 0.70*	3.4 ± 0.7*

Table 3. Albumin Levels of West Virginia Patients vs. NHANES Dataset [9] and a Large Urban Public Health System [9]

Stage

WV CKD (mean ± SE)

NHANES CKD (mean ± SE)

WV CKD (mean ± SD)

Urban Public Health System (mean ± SD)

P < 0.0001 except where *P = 0.001; †P = 0.16; ‡ = NS.

3.67 ± 0.02

4.2 ± 0.01

3.67 ± 0.58

4.0 ± 0.6

3.67 ± 0.02

4.1 ± 0.02

3.67 ± 0.57‡

3.7 ± 0.8‡

3.49 ± 0.02

4 ± 0.04

3.49 ± 0.66†

3.4 ± 0.8†

3.21 ± 0.04

4.1 ± 0.16

3.21 ± 0.70*

3.4 ± 0.7*

**Table 4.** Albumin and eGFR at Presentation by County Socioeconomic Status and Life Expectancy Rate
	% < FPL^†	Life expectancy rates^‡
*Average values at first presentation for West Virginia patients (mean ± SE); † From counties where percent of residents living below the federal poverty level exceeds national average (13.2%); ‡ From counties with low life expectancy rates.
	High	Low	High	Low
eGFR (ml/min)*	49.95 ± 0.45	43.85 ± 4.31	41.34 ± 1.00	46.75 ± 0.59
	P = 0.06	P < 0.0001
albumin (g/dl)*	3.46 ± 0.01	3.68 ± 0.08	3.71 ± 0.22	3.48 ± 0.01
	P = 0.04	P < 0.0001

Table 4. Albumin and eGFR at Presentation by County Socioeconomic Status and Life Expectancy Rate

% < FPL^†

Life expectancy rates^‡

*Average values at first presentation for West Virginia patients (mean ± SE); † From counties where percent of residents living below the federal poverty level exceeds national average (13.2%); ‡ From counties with low life expectancy rates.

High

Low

High

Low

eGFR (ml/min)*

49.95 ± 0.45

43.85 ± 4.31

41.34 ± 1.00

46.75 ± 0.59

P = 0.06

P < 0.0001

albumin (g/dl)*

3.46 ± 0.01

3.68 ± 0.08

3.71 ± 0.22

3.48 ± 0.01

P = 0.04

P < 0.0001