Serum albumin changes and mortality in patients with HIV and end-stage renal failure on peritoneal dialysis

Background Continuous ambulatory peritoneal dialysis (CAPD) is a cost-effective and easily implementable dialysis modality in end-stage renal disease (ESRD), particularly relevant to low- and middle-income countries. These countries commonly have limited renal replacement options and often a high prevalence of protein-energy wasting and poor socioeconomic conditions. We aimed to evaluate the effects of HIV infection on serum albumin changes in ESRD patients started on CAPD and concomitant effects on mortality. Methods We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly with serum albumin levels and mortality events observed during the first 18 months of CAPD therapy. Results The HIV-positive cohort had 28 recorded deaths (40%) with a functional CAPD catheter at 18 months compared to 13 deaths (18.6%) in the HIV negative cohort (<i>p</i>=0.005). The HIV positive cohort had significantly lower mean serum albumin levels compared to the HIV-negative cohort during 18 months of follow-up. At baseline, the mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% Confidence interval [CI] 2.02–6.46,<i> p</i>&lt;0.001) and at 18 months 3.99 g/L (CI 1.19–6.79, <i>p</i>=0.006). HIV-positive status (adjusted regression coefficient -2.84, CI -5.00– -0.67, <i>p</i>=0.011), diabetes (adjusted coefficient -2.85; CI, -5.58– -0.12; <i>p</i>=0.041), serum C-reactive protein and blood hemoglobin levels were independent predictors of serum albumin levels on multivariable linear regression. Baseline serum albumin &lt;25 g/L (subdistribution-hazard ratio [SHR] 13.06, CI 3.09–55.14, <i>p</i>&lt;0.001) and CD4+ cell count &lt;200 cells/µL (SHR 3.2, CI 1.38–7.45, <i>p</i>=0.007), were independent predictors of mortality in our competing risk model. Conclusions HIV infection can adversely influence serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality.