Objective This study aimed to explore the clinical characteristics of first dialysis serum albumin (ALB) level in patients with maintenance hemodialysis (MHD) and its influence on prognosis, and to analyze the value in predicting all-cause death in patients with MHD. Methods A retrospective analysis was performed in the Blood Purification Center from January 20009 to October 2022, and 1000 patients with MHD were finally included. The demographic and clinical characteristics of the patients were collected. The study endpoint was all-cause death. The optimal cut-off point of ALB is obtained by using R software. The patients were divided into groups (high ALB group and low ALB group) according to the ALB cut-off value. The clinical characteristics of patients with different ALB levels and the correlation between ALB and clinical indicators were analyzed, and the influence of ALB on the prognosis of MHD patients was evaluated. Results ALB and hemoglobin (r=0.176, P<0.001), Kt/V (r=0.217, P<0.001), URR (r=0.192, P<0.001), blood creatinine (r=0.259, P<0.001), blood calcium (r=0.225, P<0.001), blood phosphorus (r=0.225, P<0.001), PTH (r=0.196, P<0.001) are positively correlated, and negatively correlated with age (r=-0.147, P=0.001), C-reactive protein (r=-0.279, P<0.001), and glucose (r=-0.145, P<0.001). During the follow-up period, 164 patients (16.40%) died, age (HR=1.022, 95% CI: 1.010～1.034, P<0.001, PTH (HR=0.999, 95% CI: 0.998～1.000, P=0.046), urea clearance index, urea reduction rate, and ALB level is an independent predictor of mortality in MHD patients (HR=0.940, 95% CI: 0.904～0.977, P=0.002). Conclusion Low ALB level on first dialysis is an independent risk factor of all-cause death in MHD patients. MHD patients with ALB level above 39.8g/L on first dialysis have a better prognosis. Clinicians should pay attention to the ALB level of MHD patients on first dialysis. The higher the ALB level of MHD patients on first dialysis, the lower the risk of all-cause death.
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