GFR decline according to baseline characteristics in participants followed up 2^nd examination.

<p>*GFR decline*: GFR decline rate (ml/min/1.73 m²/year) estimated by covariate analysis adjusted for age, gender, DM, HTN, GFR, and proteinuria by dipstick test at baseline study.</p><p>**The number with bold character indicates GFR increase rate.</p

Basal characteristics of elderly population at baseline study according to age.

<p>GFR: Calculated by CKD-EPI equation, BMI: body mass index, Proteinuria: measured by dipstick test, Anemia: defined in female with hemoglobin less than 12 g/dL and, in male, less than 13 g/dL. Hematuria: RBC≥5/HPF, Anti-platelet agent: aspirin 100 mg, triflusal, sarpogrelate, or clopidogrel, No of AntiHTN: number of antihypertensive medication.</p

Participants in KLoSHA study.

<p>*Mortality was detected by direct contact and the national database. **Mortality was identified by the national database.</p

The survival rate according to GFR and proteinuria.

<p>A. GFR group for all-caused mortality. B. Proteinuria group for all-caused mortality *p-value by Log-rank test.</p

The event rate of all-cause mortality according to basal characteristics.

<p>*ACM: all-cause mortality, p-value: calculated by Pearson’s Chi-square test, 100 PY: 100 person-years.</p

Survival according to the acute kidney injury (AKI) stage.

<p>(A) Death-free survival during admission. Patient survival decreased as the AKI stage increased, including pre-stage AKI (log-rank, P < 0.001). (B) Death-free survival during the follow-up. Patient survival decreased as the AKI stage increased, including pre-stage AKI (log-rank, P < 0.001).</p

Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study

<div><p>Background</p><p>Development of acute kidney injury (AKI) is common and is associated with poor outcomes. We aimed to determine whether hypoalbuminemia (HA) at admission could be a risk factor for the development of AKI and mortality in hospitalized patients.</p><p>Methods</p><p>We enrolled patients who were admitted to Seoul National University Bundang Hospital from January 2013 to December 2013. HA at admission was defined as a serum albumin level < 3.4 mg/dL measured within two days after admission. AKI was defined as an increase in the serum creatinine level by ≥0.3 mg/dL or ≥1.5 times of the baseline value during the hospital stay.</p><p>Results</p><p>A total of 19,472 patients were enrolled and divided into HA and normoalbuminemia (NA) groups at admission. The incidence of AKI was 10.7% (340/3179) in the HA group and 4.1% (662/16293) in the NA group (adjusted odds ratio [OR], 1.243; 95% confidence interval [CI], 1.069–1.445; <i>P</i> = 0.005). The hazard ratios for the 30-day, 90-day, and 1-year mortality were 1.873 (95% CI, 1.383–2.537; <i>P</i> < 0.001), 1.710 (95% CI, 1.410–2.072; <i>P</i> < 0.001), and 1.372 (95% CI, 1.214–1.551; <i>P</i> < 0.001), compared to the NA group. In patients with AKI, albumin replacement improved renal recovery (OR, 2.605; 95% CI, 1.450–4.681; <i>P</i> = 0.001). The mortality rate was not different according to albumin replacement.</p><p>Conclusions</p><p>HA is associated with the development of AKI and high mortality in hospitalized patients. Replacement of albumin after the development of AKI may contribute to renal recovery. Further clinical trials are warranted.</p></div

Cumulative patient survival after ESRD progression according to the all ESRD patients

<p>(<b>A</b>) <b>and excluding transplantation recipients</b> (<b>B</b>)<b>.</b> The primary outcome is patient survival. The numbers of patients remaining at 60, 120, 180, 240, 300, and 360 months of follow-up are shown at the bottom. ESRD, end stage renal disease.</p

Outcomes of pre-stage acute kidney injury (AKI).

<p>(A) The duration of admission in patients with pre-stage AKI was significantly longer than in patients without AKI. (B) Total medical costs according to the stages of AKI are presented. The total medical costs gradually increased as the stage of AKI, including pre-AKI, increased (P < 0.001). *, significant difference (P < 0.05) compared to the patients without AKI.</p

Pathologic changes of study population.

<p>All continuous variables are shown as mean (SD) for normal distributions, or median (interquartile range) for non-parametric variables. Categorical variables were frequency per observation (N (%)). Pathological characteristics for patients who progressed to the primary outcome were compared with those who did not using χ² test for dichotomous variables, and student t-test for parametric continuous variables. Abbreviations: ESRD, end stage renal disease; TA, tubular atrophy;</p