# Hypoalbuminemia and Hospitalization Risk in Mexican Patients With End-Stage Renal Disease on Hemodialysis: A Single-Center, Retrospective, Cross-Sectional Study

## TL;DR

Low albumin levels in hemodialysis patients are strongly linked to higher hospitalization rates and longer stays in Mexico.

## Contribution

This study identifies hypoalbuminemia as a significant risk factor for hospitalization in Mexican HD patients, emphasizing the need for routine monitoring.

## Key findings

- 77% of hypoalbuminemic patients were hospitalized versus 25.7% of normoalbuminemic patients.
- Hypoalbuminemic patients had significantly longer hospital stays (11.82 days) compared to normoalbuminemic patients (3.96 days).
- The odds of hospitalization were 9.69 times higher for hypoalbuminemic patients.

## Abstract

Background and objective

Hypoalbuminemia in hemodialysis (HD), commonly defined as serum albumin <3.5 g/dL, is multifactorial and linked to adverse outcomes, including higher hospitalization rates. We aimed to evaluate the association between hypoalbuminemia and hospitalization among adults with end-stage renal disease (ESRD) on maintenance HD at a secondary-care hospital in Mexico.

Methods

We performed a retrospective, cross-sectional, analytical study of clinical records from July 2022 to June 2023. Patients were categorized into two groups: Group 1 (G1), those with hypoalbuminemia (<3.5 g/dL), and Group 2 (G2), those with normoalbuminemia (≥3.5 g/dL). The primary outcome was hospitalization (yes/no), with length of stay as a secondary outcome. Comparisons between groups were performed using the Chi-square test for categorical variables and the Mann-Whitney U test for continuous variables with non-normal distributions. Odds ratios (ORs) with 95% confidence intervals (95% CI) were estimated, and a two-sided p value <0.05 was considered statistically significant.

Results

We analyzed a total of 226 records (mean age: 49.8 ± 16.2 years; 60.6% male) (mean age: 49.8 ± 16.2 years; 60.6% male), with diabetes being the most common comorbidity. Hospitalization was observed in 77.0% of patients in G1 compared with 25.7% in G2, demonstrating a strong association (χ² = 59.58, p<0.001) and a crude OR of 9.69 (95% CI: 5.60-16.50). The length of hospital stay was significantly longer in G1 than in G2 (11.82 ± 12.69 vs. 3.96 ± 9.40 days; p<0.001).

Conclusions

Hypoalbuminemia in HD patients is strongly associated with both higher hospitalization risk and longer hospital stays. Routine albumin surveillance may help identify high-risk patients and prompt targeted interventions - nutritional optimization, infection/inflammation management, and dialysis adequacy checks - to reduce healthcare utilization and improve clinical outcomes.