Hypoalbuminemia is an important risk factor of hypotension during hemodialysis

Nakamoto, Hidetomo; Honda, Nobuko; Mimura, Taku; Suzuki, Hiromichi

doi:10.1111/j.1542-4758.2006.00122.x

Cited by 15 publications

(14 citation statements)

References 22 publications

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“…Hypoalbuminemia is associated with hypotension [23], progressive left ventricular dysfunction [24] and reduced intra-dialytic skin blood flow [25] and is due to decreased synthesis; attempts to correct hypoalbuminemia have not resulted in improved mortality so far [26-37]. …”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia in hemodialyzed end stage renal disease patients: risk factors and relationships - a 2 year single center study

Sridhar

Josyula²

2013

BMC Nephrol

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BackgroundMalnutrition affects 1/3 of hemodialysis patients and associates with a higher risk of morbidity and mortality. Serum albumin is a marker of nutrition and inflammation, and predicts mortality, particularly when <3.8 g/dL. This study was performed to identify risk factors for hypoalbuminemia (<3.8 g/dL) and the particular temporal relationship and strength of association between protein intake (nPCR) and serum albumin when confounding variables are taken into account.MethodsDemographic, clinical, and dialysis-related data of 57 ESRD patients on hemodialysis over 24 months in 6 temporal segments were analyzed with serum albumin as a continuous, and categorical outcome (with 3.8 g/dl as cut-off) variable , against 13 potential independent variables [4 demographic factors, 3 nutrition-related, and 5 morbidity-related parameters, and % urea reduction ratio (URR)]. The temporal relationships between albumin and nPCR were analyzed for the concurrent & 3 subsequent months in each temporal segment.ResultsThe impact of nPCR on serum albumin (p < 0.05) was significant but with no discernible temporal relationship. Advancing age, longer vintage, female gender, diabetes mellitus, nPCR, serum phosphate and ferritin had significant correlation with albumin <3.8 g/dl (p < 0.05). Serum phosphate levels correlated positively, and fever, bacteremia, hospital stay and weight loss negatively, with mean serum albumin but did not negate the effect of nPCR. Regression analysis showed that mean albumin associated with nPCR, fever, hospital stay, bacteremia, dialysis vintage, age, sex, and diabetes mellitus; and that an albumin level of <3.8 g/dl associated with age, female sex, diabetes, lower nPCR, and higher ferritin.ConclusionSuggested target albumin levels were not met in elderly, female, and diabetic patients. The association of nPCR with albumin was not nullified by confounding demographic or morbidity-related factors. nPCR had no demonstrable temporal relationship with albumin.

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Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia in hemodialyzed end stage renal disease patients: risk factors and relationships - a 2 year single center study

Sridhar

Josyula²

2013

BMC Nephrol

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“…Patient comorbidities associated with risk for IDH include diabetes mellitus, coronary artery disease, systolic dysfunction, left ventricular hypertrophy, and elevated cardiac troponin . Patient factors that are more amenable to treatment and change include hyperphosphatemia, anti‐hypertensive medication use, ingestion of a meal before hemodialysis, increased body mass index, lower albumin levels, and interdialytic weight gain …”

Section: Risk Factors Of Idhmentioning

confidence: 99%

A brief review of intradialytic hypotension with a focus on survival

Chou

Kalantar-Zadeh

Mathew

2017

Seminars in Dialysis

103

106

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Intradialytic hypotension (IDH), a common complication of ultrafiltration during hemodialysis therapy, is associated with high mortality and morbidity. IDH, defined as a nadir systolic blood pressure of less than 90 mmHg on more than 30% of treatments, is a relevant definition and is correlated with mortality. Risk factors for IDH include patient demographics, anti-hypertensive medication use, larger interdialytic weight gain, and dialysis prescription features as dialysate sodium, high ultrafiltration rate, and dialysate temperature. A high frequency of IDH events carries a substantial death risk. An ultrafiltration rate >10mL/hr/kg, and even more so >13mL/hr/kg, is highly predictive of cardiovascular and all-cause mortality. Evidence suggests that IDH causes acute reversible segmental myocardial hypoperfusion and contractile dysfunction (myocardial stunning), which can result in long-term loss of myocardial contractility, leading to premature death. IDH also has negative end-organ effects on the brain and gut, contributing to mortality through stroke, and endotoxin translocation with associated inflammation and protein-energy wasting. Given strong association of IDH and dialysis mortality, a paradigm shift to its approach is urgently needed. Randomized controlled trials are required to prospectively test drugs and monitoring devices which may reduce IDH.

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“…(3) Hypoalbuminemia is an important risk factor of hypotension during hemodialysis. (5) Also, hypoalbuminemia was an important risk factor for progressive left ventricular hypertrophy in patients with end stage renal disease (ESRD). (6)…”

Section: Introductionmentioning

confidence: 99%

The Association between Hypoalbuminemia and Intradialytic Hypotension in Heamodialysis Patients

Al-Etreby

El-Aziz

El-Waseef

et al. 2016

EJHM

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Background: hypoalbuminemia is an important risk factor of hypotension during hemodialysis and progressive left ventricular hypertrophy in patients with chronic kidney disease (CKD). Aim of the study: this study was done to evaluate the relationship between serum albumin and intradialytic hypotension (IDH) and cardiac functions. Patients and Methods: forty patients on regular hemodialysis (HD) were included in the present study. They have been divided into two groups; Group 1: Patients of this group developed recurrent attacks of IDH and Group 2: Patients of this group not developed IDH. The patients have been classified again according to serum albumin level into two groups; Group A: Hypoalbuminemic patients and Group B: Non-hypoalbuminemic patients. Data collected from each patient included: (1) Demographic features (age, gender) and clinical features (blood pressure changes during session, ultrafiltration rate, cardiothoracic ratio, duration of dialysis and Kt/V); (2) Blood chemistry (creatinine, urea, hemoglobin, hematocrit value, total proteins, albumin, triglycerides, cholesterol, AST, ALT, Kt/V, and fasting blood sugar); and (3) Echocardiographic assessment of left ventricular geometry. Results: there was a significant negative correlation between serum albumin and Delta BP in HD patients. Also we found no significant changes in cardiac functions among different studied groups. Conclusion: We concluded that there was a relationship between low serum albumin and intradialytic hypotention and cardiac functions in CKD patients undergoing HD. Recommendations: Regular assessment of serum albumin is mandatory for all HD patients.

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Hypoalbuminemia is an important risk factor of hypotension during hemodialysis

Cited by 15 publications

References 22 publications

Hypoalbuminemia in hemodialyzed end stage renal disease patients: risk factors and relationships - a 2 year single center study

Hypoalbuminemia in hemodialyzed end stage renal disease patients: risk factors and relationships - a 2 year single center study

A brief review of intradialytic hypotension with a focus on survival

The Association between Hypoalbuminemia and Intradialytic Hypotension in Heamodialysis Patients

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