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 (p=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, p<0.001) and at 18 months
3.99 g/L (CI 1.19–6.79, p=0.006). HIV-positive
status (adjusted regression coefficient -2.84, CI -5.00– -0.67, p=0.011), diabetes (adjusted coefficient -2.85; CI,
-5.58– -0.12; p=0.041), serum
C-reactive protein and blood hemoglobin levels were
independent predictors of serum albumin levels on multivariable linear
regression. Baseline serum albumin <25 g/L (subdistribution-hazard ratio [SHR]
13.06, CI 3.09–55.14, p<0.001) and CD4+ cell count <200 cells/µL
(SHR 3.2, CI 1.38–7.45, p=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.