Identification of independent risk factors for hypoalbuminemia in patients with CKD stages 3 and 4: the construction of a nomogram

Background: Hypoalbuminemia is a common complication in patients with chronic kidney disease (CKD) and is associated with various adverse clinical events. Currently, there are few studies focused on identifying risk factors and constructing models for hypoalbuminemia in patients with CKD stages 3 and 4. This study aims to identify independent risk factors for hypoalbuminemia in patients with CKD stages 3 and 4 and construct a nomogram for predicting the risk of hypoalbuminemia in these patients.

Methods: A total of 237 patients with CKD stages 3 and 4 treated at Anning First People's Hospital from January to December 2023 were included. Univariate and bidirectional stepwise multivariate logistic regression analyses were used to identify independent risk factors for hypoalbuminemia in these patients. Based on the results of logistic regression analyses, a nomogram was constructed. The model performance was assessed using area under the receiver operator characteristic curve, calibration curves, and decision curve analysis.

Results: Hemoglobin, red blood cells, serum sodium, and serum calcium were identified as independent risk factors for hypoalbuminemia in these patients. The contributions of each independent risk factor to hypoalbuminemia were visualized in a nomogram. The area under the receiver operator characteristic curve of the model was 0.819, indicating good discrimination. The calibration curves showed good agreement between predicted and observed outcomes. The decision curve analysis also verified that the model had the good clinical utility.

Conclusion: Hemoglobin, red blood cells, serum sodium, and serum calcium were identified as independent risk factors of hypoalbuminemia in patients with CKD stages 3 and 4. The nomogram exhibits good discrimination, calibration, and clinical utility, offering a reliable tool for the early prediction and identification of hypoalbuminemia in these patients.