The Relationship Between Serum Albumin/globulin Ratio And Prognosis Of Patients On Peritoneal Dialysis

BackgroundAlbumin/globulin ratio(AGR),a variable based on serum albumin and non-albumin proteins,has been demonstrated as a predictor of mortality in patients with malignant neoplasm or other chronic diseases.But it was unclear whether AGR had prognostic value on peritoneal dialysis(PD)patients.AimThe aim of this study was to evaluate the prognostic value of AGR on PD patients.MethodsWe retrospectively analyzed 602 incident PD patients from January 1st,2008,to December 31 st,2017,at our center and followed them until December 31 st,2018.IBM SPSS Statistics 20.0 software and R were applied to complete the statistical analysis.The median of AGR was 1.25,Patients whose AGR ?1.25 were entered into the low AGR group,and all others were included in the high AGR group.The characteristic differences between the baseline data of the two groups were compared using the T-test,Chi-square test,or Mann-Whitney U test,as appropriate.The association between AGR and clinical characteristics and laboratory data was analyzed using Spearman's rank correlation analysis.Kaplan-Meier curves were performed to present the survival rates of the two groups,and the differences were assessed by log-rank test.While taking the competitive risks of drop out due to causes other than death into consideration,Gray's test was used to compare the difference of cumulative mortality incidence between the two groups.Multivariate Cox regression models were applied to analyze the association between AGR and all-cause of mortality and cardiovascular mortality.p<0.05 was considered to be statistically significant.Results1.Six hundred-two PD patients met the inclusion criterion and were incorporated into this study.There were statistically significant in age,gender,diabetes,Charlson comorbidity index(CCI),leukocytes,red cell distribution width(RDW),platelet counts,urea nitrogen,serum creatinine,albumin-corrected calcium,and phosphorus between the two groups.2.The analysis of Spearman's rank correlation showed that AGR level negatively correlated with age,CCI,serum total protein,leukocytes,RDW,platelet counts,and albumin-corrected calcium.In addition,AGR positively correlated with serum albumin,phosphorus,serum creatinine,and urea nitrogen.Serum albumin positively correlated with serum total protein,hemoglobin,serum creatinine,and urea nitrogen,and negatively correlated with age,CCI,and RDW.In addition,globulin positively correlated with serum total protein,age,CCI,leukocytes,RDW,platelet counts and glucose,and also negatively correlated with serum creatinine and urea nitrogen.3.The Kaplan-Meier curves presented significant differences in all-cause survival(log-rank=24.84,p<0.001)and cardiovascular survival(log-rank=14.02,p<0.001)of the two AGR groups.4.The competing risk model showed that when considering drop out due to other causes as competitive risks,the risk of cumulative mortality incidence was significantly higher in patients in the low AGR group than in the high AGR group(Gray test 25.28,p<0.001).5.Multivariate Cox regression models showed that after adjusting for potential confounders,the lower AGR level was significantly associated with an increased all-cause(HR:1.57,95%CI:1.07-2.32,p=0.022)and cardiovascular mortality(HR:2.01,95%CI:1.10-3.69,p=0.023).Conclusions1.AGR level negatively correlated with age,CCI,serum total protein,leukocytes,RDW,platelet counts,and albumin-corrected calcium.In addition,AGR positively correlated with serum albumin,phosphorus,serum creatinine,and urea nitrogen.2.Patients with a low AGR level had an increased all-cause and cardiovascular mortality.AGR may be a useful index in evaluating the prognosis of PD patients.