Relationship between serum protein and mortality in adults on long-term hemodialysis: Exhaustive review and meta-analysis

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dc.contributor.authorHerselman M.
dc.contributor.authorEsau N.
dc.contributor.authorKruger J.-M.
dc.contributor.authorLabadarios D.
dc.contributor.authorMoosa M.R.
dc.date.accessioned2011-05-15T16:17:32Z
dc.date.available2011-05-15T16:17:32Z
dc.date.issued2010
dc.description.abstractThe aim of this exhaustive review and meta-analysis was to explore the relation among serum protein, inflammatory markers, and all-cause and cardiovascular mortalities in adult patients on maintenance hemodialysis. We searched the Medline, Science Citation Index, Academic Search Premier, Cochrane Library, and Embase electronic data bases. Data extraction and quality assessment were done independently by two reviewers and results were pooled using the random effects model. Cochran's Q was used to identify heterogeneity and a funnel plot was used for assessment of publication bias. A meta-analysis was performed on 38 studies (265 330 patients) reporting on serum proteins, inflammatory markers, and mortality. A significant inverse relation was found between serum albumin and all-cause (hazard ratio [HR] 0.7038, 95% confidence interval [CI] 0.6367-0.7781) and cardiovascular (HR 0.8726, 95% CI 0.7909-0.9628) mortalities, with a significantly stronger relation with all-cause mortality (P = 0.0014). Pooled results for C-reactive protein showed a weak but significant direct relation with all-cause mortality (HR 1.0322, 95% CI 1.0151-1.0496), but there was not a significant relation between C-reactive protein and cardiovascular mortality (HR 1.0172, 95% CI 0.9726-1.0639). A high degree of heterogeneity was identified among studies especially in the case of all-cause mortality. An asymmetrical funnel plot for serum albumin is suggestive of publication bias. From the meta-analysis it is concluded that serum albumin showed a significant inverse relation with all-cause and cardiovascular mortalities but the relation between prealbumin and all-cause mortality was not significant. C-reactive protein showed a significant direct relation with all-cause mortality but not with cardiovascular mortality. The potential adverse effects of malnutrition and infections in relation to mortality highlight the need for continued treatment of infections and correction of malnutrition in patients on dialysis. © 2010 Elsevier Inc. All rights reserved.
dc.description.versionReview
dc.identifier.citationNutrition
dc.identifier.citation26
dc.identifier.citation1
dc.identifier.issn08999007
dc.identifier.other10.1016/j.nut.2009.07.009
dc.identifier.urihttp://hdl.handle.net/10019.1/14258
dc.subjectalbumin
dc.subjectC reactive protein
dc.subjectprealbumin
dc.subjectalbumin blood level
dc.subjectcardiovascular disease
dc.subjectCochrane Library
dc.subjectEMBASE
dc.subjecthemodialysis
dc.subjecthemodialysis patient
dc.subjecthuman
dc.subjectinfection
dc.subjectinflammation
dc.subjectlong term care
dc.subjectmalnutrition
dc.subjectMEDLINE
dc.subjectmortality
dc.subjectnutritional support
dc.subjectpatient monitoring
dc.subjectpriority journal
dc.subjectprotein blood level
dc.subjectpublishing
dc.subjectreview
dc.subjectSciSearch
dc.subjectAdult
dc.subjectBiological Markers
dc.subjectC-Reactive Protein
dc.subjectCardiovascular Diseases
dc.subjectCause of Death
dc.subjectHumans
dc.subjectInfection
dc.subjectKidney Failure, Chronic
dc.subjectProtein-Energy Malnutrition
dc.subjectRenal Dialysis
dc.subjectSerum Albumin
dc.titleRelationship between serum protein and mortality in adults on long-term hemodialysis: Exhaustive review and meta-analysis
dc.typeReview
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