The advantage of
hemodiafiltration (HDF) is well known. One of the disadvantages of HDF is loss of
serum albumin, but this issue is still obscure. Some risk factors associated with mortality were age dependent. Studies on
serum albumin/
hypoalbuminemia and HDF in different age stratification were limited. The aim of this cross-sectional study was to assess the role of HDF and other clinical variables on
serum albumin values in maintenance
hemodialysis (MHD) patients of different age groups. We recruited a total of 1216 patients on MHD. Patients were divided into 4 groups by age stratification of youth (<30 years old), young-middle age (30-44 years old), middle age (45-64 years old), and old age (≥65 years old). Biochemical, hematological, nutritional, inflammatory parameters, and receiving HDF or not were recorded. The associations between age groups, HDF, and variables mentioned above were analyzed. Only in middle-age group, patients with HDF was significantly (P = 0.013) associated with
serum albumin <4 g/dL. In middle-age group, a multivariate-forward logistic regression analysis showed that male sex (2.169 [1.029, 4.574], P = 0.042),
inflammation (4.167 [2.043, 8.498], P < 0.001),
cardiovascular disease (2.92 [1.019, 8.402], P = 0.046), serum
creatinine level (0.639 [0.538, 0.758], P < 0.001), and
cholesterol level (0.984 [0.975, 0.993], P = 0.001) were associated with
serum albumin level <3.6 g/dL. Hepatitis C virus
infection (1.911 [1.186, 3.077], P = 0.008), HDF (2.143 [1.298, 3.540], P = 0.003),
inflammation (2.309 [1.549, 3.440], P < 0.001), use of arterio-venous
fistula (0.518 [0.327, 0.820], P = 0.005), Kt/V (0.395 [0.193, 0.809], P = 0.011), nonanuria (0.542 [0.337, 0.870], P = 0.011), serum
creatinine level (0.744 [0.669, 0.828], P < 0.001), and
cholesterol level (0.993 [0.987, 0.998], P = 0.013) were associated with
serum albumin level <4 g/dL. HDF can predict
serum albumin level <4 g/dL in middle-age HD patients. The effect of age needs to be taken into consideration when interpreting the correlation between
hypoalbuminemia and HDF.