Comparison of serum albumin, C-reactive protein and carotid atherosclerosis as predictors of 10-year mortality in hemodialysis patients

Hemodial Int. 2010 Apr;14(2):226-32. doi: 10.1111/j.1542-4758.2009.00432.x. Epub 2010 Mar 24.


Serum albumin, C-reactive protein (CRP), and the intima-medial thickness of the common carotid artery (CA-IMT) are associated with clinical outcomes in hemodialysis (HD) patients. However, it remains unclear which parameters are more reliable as predictors of long-term mortality. We measured serum albumin, CRP, and CA-IMT in 206 HD patients younger than 80 years old, and followed them for the next 10 years. One hundred sixty-eight patients (age: 57 +/- 11 years, time on HD: 11 +/- 7 years) were enrolled in the analyses. We divided all patients into three tertiles according to their albumin levels, and conducted multivariate analyses to examine the impact on 10-year mortality. Seventy-three (43.5%) patients had expired during the follow-up. Serum albumin was significantly lower in the expired patients than in the surviving patients (3.8 +/- 0.3 vs. 4.0 +/- 0.3, P<0.01), while CRP (4.7 +/- 5.0 vs. 2.8 +/- 3.5 g/L, P=0.01) and CA-IMT (0.70 +/- 0.15 vs. 0.59 +/- 0.11 mm, P<0.01) were significantly higher in the expired group. The multivariate analysis revealed that there was a significantly higher risk for total mortality in HD patients with serum albumin <3.8 g/dL (odds ratio 5.04 [95% CI: 1.30-19.60], P=0.02) when compared with those with albumin >4.1 g/dL. In contrast, CRP and CA-IMT did not associate with total death. It follows from these findings that serum albumin is more superior as a mortality predictor compared with CRP and CA-IMT in HD patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / metabolism
  • Carotid Artery Diseases / mortality*
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Artery, Common / metabolism
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Dropouts
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Renal Dialysis / mortality*
  • Risk Factors
  • Serum Albumin / metabolism*
  • Ultrasonography


  • Biomarkers
  • Serum Albumin
  • C-Reactive Protein