Serum Albumin Levels Can Predict Increased Cancer Risk in Hemodialysis

New findings highlight low serum albumin levels as a predictor of increased risk of cancer and subsequent mortality in patients undergoing maintenance hemodialysis (HD).1

“The results demonstrated the inverse association of serum albumin levels with cancer risk and overall mortality after cancer diagnosis in patients undergoing maintenance HD,” wrote study investigator Seok Hui Kang, MD, PhD, an associate professor and academic researcher at Yeungnam University, and colleagues. “They support the value of regular monitoring of serum albumin as part of a comprehensive patient assessment in patients undergoing HD.”1

Cancer incidence and cancer-specific mortality are elevated among patients with end-stage kidney disease (ESKD) compared with the general population. Although prior studies have examined cancer risk in patients with ESKD undergoing hemodialysis, the association between serum albumin levels and cancer risk in this population remains unclear.2

To address this gap in research, Kang and colleagues analyzed HD quality assessment program data from the Korean Health Insurance Review and Assessment Service. The primary exposure of interest was serum albumin level (g/dL), measured as part of routine laboratory testing.1

Investigators collected monthly data on hemoglobin levels, body mass index, Kt/Vurea, serum phosphorus levels, serum creatinine levels, and ultrafiltration volume. The incidence of any cancer was defined as the presence of ICD-10 codes for 12 cancers between the endpoint and follow-up. Survival duration was calculated as time between diagnosis of any cancer and time of death or censoring.1

The retrospective cohort study included 64,728 adult patients ≥ 18 years of age undergoing maintenance HD for ≥3 months and ≥2 times per week. Investigators stratified patients into quintiles based on their serum albumin levels: 1Q (3.12–3.72 g/dL), 2Q (3.73–3.92 g/dL), 3Q (3.93–4.06 g/dL), 4Q (4.07–4.21 g/dL), and 5Q (4.25–4.73 g/dL).1

Since baseline characteristics were significantly different between each quintile, investigators used propensity score weighting to balance them using generalized boosted models for patient demographics, comorbidities, dialysis parameters, labs, medications, and cardiovascular history. After characteristic balancing, follow-up, and cancer-free and post-diagnosis patient survival rates were broadly similar across quintiles.1

From the results of the univariable and multivariable Cox regression analyses, investigators observed increased risks of cancer in the 1Q and 2Q groups compared to the 3Q group (adjusted HR [aHR], 1.12; 95% CI, 1.08–1.16 for 1Q vs 3Q; aHR, 1.08; 95% CI, 1.04–1.12 for 2Q vs. 3Q). Accordingly, the 4Q group had a decreased risk of cancer than the 3Q group (aHR, 0.94; 95% CI, 0.91–0.98). Regarding all-cause mortality among patients with cancer, the 1Q group had an increased risk of all-cause mortality than the 3Q group (aHR, 1.16; 95% CI, 1.11–1.22).1

Investigators conducted subgroup analyses by age (≥60 years) and sex. In multivariable models, they discerned an association with decreased serum albumin levels and an increased risk of cancer and subsequent all-cause mortality across both subgroups, with a pronounced association among patients <60 years and among women. In male participants, increased serum albumin levels were linked to a decreased risk of all-cause mortality after a cancer diagnosis. Conversely, in female participants, increased albumin levels were associated with an increased risk of all-cause mortality.¹

In a subgroup analyses of cancer types, the association between decreased albumin levels and cancer risk was strongest for gallbladder or bile duct cancer (aHR, 1.54; 95% CI, 1.27–1.87 for 1Q vs. 3Q) and for uterine or cervical cancer (aHR, 1.64; 95% CI, 1.34–2.00 for 1Q vs. 3Q). Generally, increased albumin levels (4Q–5Q) were associated with decreased risks of cancer. Investigators noted this was not uniform across all cancer types. For example, patients in the highest quintile (5Q) demonstrated a significantly increased risk of prostate, gallbladder, bile duct, uterine, cervical, and bladder cancers.1

After a cancer diagnosis, Kang and colleagues noted that decreased albumin levels were associated with increased risks of all-cause mortality in most types. However, in thyroid, breast, and liver cancers, the uppermost serum albumin group (5Q) was associated with an increased risk of mortality. From these findings, investigators deduced that baseline serum albumin levels may not be uniformly associated with increased survival across all types of cancers.1

“Although we demonstrated an association between serum albumin levels and cancer incidence, this relationship was only modest and may be influenced by numerous confounding factors,” investigators concluded.”Therefore, it is difficult to recommend any modification of cancer screening strategies based solely on our findings. Such recommendations would require a thorough analysis of diagnostic performance metrics, including sensitivity and specificity.”1

References

1. Kim M, Park SY, Lim YJ, et al. Low serum albumin levels as a predictor of increased risk of cancer in patients undergoing maintenance hemodialysis. Kidney Research and Clinical Practice. Published online December 4, 2025. doi:https://doi.org/10.23876/j.krcp.25.155

2. Taborelli M, Toffolutti F, Del Zotto S, et al. Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy. BMC Nephrology. 2019;20(1). doi:https://doi.org/10.1186/s12882-019-1283-4