Association Between Serum Prealbumin Level and Outcomes in Prevalent Kidney Transplant Recipients

J Ren Nutr. 2019 May;29(3):188-195. doi: 10.1053/j.jrn.2019.01.003. Epub 2019 Feb 26.


Objective(s): Prealbumin, a transport protein mostly synthesized in the liver, is a marker of nutrition. Although decreased prealbumin levels are associated with increased mortality in end-stage kidney disease patients, its association with mortality in kidney transplant recipients remains unknown. We evaluated the association between prealbumin levels and outcomes in kidney transplant recipients.

Design: This was a prospective prevalent cohort study. This study included 991 kidney transplant recipients enrolled from December 31, 2006, to December 31, 2007, and followed over a 6-year period. Sociodemographic, past medical history, clinical, and laboratory data were collected at the study entry. Associations between prealbumin levels and death with functioning graft, all-cause mortality, and graft loss were examined using survival models.

Results: Serum prealbumin levels showed significant negative correlation with estimated glomerular filtration rate (R = -0.28; P < .001) and high-sensitive C-reactive protein (R = -0.24; P < .001). Each 5 mg/dL lower serum prealbumin level was associated with 20% higher risk of death with functioning graft (subdistribution hazard ratio [95% confidence interval]: 1.20 [1.08-1.35]; P = .001), which persisted after multivariable adjustments (subdistribution hazard ratio [95% confidence interval]: 1.13 [1.00-1.28]; P = .039). Qualitatively similar trend was observed in all-cause mortality; however, there was no association between prealbumin levels and graft loss.

Conclusion(s): Lower serum prealbumin level is associated with increased risk of death with functioning graft in prevalent kidney transplant recipients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • C-Reactive Protein / analysis
  • Cohort Studies
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection / epidemiology
  • Graft Survival / physiology*
  • Humans
  • Kidney Transplantation* / mortality
  • Male
  • Middle Aged
  • Prealbumin / analysis*
  • Prospective Studies
  • Treatment Outcome


  • Prealbumin
  • C-Reactive Protein