Serum Albumin as Predictor of Nutritional Status in Patients with ESRD

Gama-Axelsson, Thiane; Heimbürger, Olof; Stenvinkel, Peter; Bárány, Peter; Lindholm, Bengt; Qureshi, Abdul Rashid

doi:10.2215/cjn.10251011

Cited by 164 publications

(115 citation statements)

References 29 publications

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“…Although serum albumin is still considered a biomarker of nutritional status in dialysis patients, it correlates poorly with nutritional status markers in this patient group. 48,49 Several groups have reported that the strong association between serum albumin and mortality in dialysis patients is explained by persistent inflammation rather than by malnutrition. 49,50 Finally, BMI is a crude marker of body composition and does not accurately differentiate between lean and fat tissue.…”

Section: Discussionmentioning

confidence: 99%

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Stenvinkel

Gillespie

Tunks

et al. 2015

JASN

Self Cite

100

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High body mass index (BMI) is paradoxically associated with better outcome in hemodialysis (HD) patients. Persistent inflammation commonly features in clinical conditions where the obesity paradox is described. We examined the relationship between BMI and mortality in HD patients, accounting for inflammation, in a historic cohort study of 5904 incident HD patients enrolled in 2007-2009 (312 facilities; 15 European countries) with $3 months of follow-up. Patients were classified by presence (n=3231) or absence (n=2673) of inflammation (C-reactive protein $10 mg/l and/or albumin #35 g/l). Patients were divided into quintiles by 21.5,and .29.8 kg/m 2 , respectively). Noninflamed patients in BMI Q5 formed the reference group. During a median follow-up period of 36.7 months, 1929 deaths occurred (822 cardiovascular), with 655 patients censored for renal transplantation and 1183 for loss to follow-up. Greater mortality was observed in inflamed patients (P,0.001). In fully adjusted time-dependent analyses, the all-cause mortality risk in noninflamed patients was higher only in the lowest BMI quintile (hazard ratio [HR, 1.80 . Thus, whereas a protective effect of high BMI was observed in inflamed patients, this effect was mitigated in noninflamed patients.

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Section: Discussionmentioning

confidence: 99%

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Stenvinkel

Gillespie

Tunks

et al. 2015

JASN

Self Cite

100

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“…plasma volume) and urinary albumin losses. 17 Moreover there is a reduction in the albumin synthesis during acute illness. The presence of acute or chronic inflammation limits the specificity of serum albumin as a nutritional marker.…”

Section: Discussionmentioning

confidence: 99%

Subjective global assessment of the patients of chronic kidney disease undergoing dialysis

Gupta

Srivastava

Narain³

et al. 2017

Int J Adv Med

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Background: Malnutrition is an important risk factor in patients with chronic kidney disease and in those undergoing maintenance dialysis. Subjective global assessment is a reliable method to evaluate malnutrition in these patients. This study aims to evaluate malnutrition in patients of chronic kidney disease using subjective global assesment score.Methods: A cross sectional study was conducted at SRN Hospital, Allahabad, Uttar Pradesh, India on patients attending Nephrology Unit from July 2014 to May 2015.The nutritional status of 100 patients was evaluated using dietary recall, anthropometry, biochemical parameter and subjective global assessment. There were 67 males and 23 females. Their mean age was 46.8 years. Subjective global assessment was done using 7 variables derived from medical history and physical examination. Each variable was scored from 1-5 depending on the severity. The subjective global assessment score was correlated with the standard methods.Results: Out of 100 patients 29% were mildly malnourished, 64% were moderately malnourished and 7% were severely malnourished. The age, triceps thickness, serum urea and cholesterol were correlated with the malnutrition score (r value 0.2, -0.3, 0.2, 0.4 respectively and p-value 0.3, 0.002, 0.007, 0.001 respectively). It was found that the serum albumin (r value -0.21, p-value 0.42) level did not correlate well with the subjective global assessment.Conclusions: The subjective global assessment can be used reliably to assess the malnutrition in the patients of chronic kidney disease and hence useful in prognostication of disease and is a convenient bedside tool, operable even with paramedics.

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“…Bu sebeple serum albümin seviyesinin diyaliz hastalarında beslenme durumunu belirlemek için iyi bir belirleyici olmadığı öne sürülmektedir (12,16). Tüm bu sonuçlara ve beslenme durumunu saptamak için kullanılabilecek farklı alternatif metotlara rağmen kronik böbrek yetmezliği olan hastalarda beslenme durumunun saptanmasında en yaygın olarak serum albümin seviyesi kullanılmaktadır (17). Serum albümin düzeyi 4.0 g/dL'nin altında olan hastalar malnütrisyonlu olarak tanımlanmaktadır (15).…”

Section: Malnütrisyon Göstergesi Olarak Hipoalbüminemiunclassified

“…Üremi ve üremik sendroma eşlik eden semptomlar proinflamatuvar sitokinlerin aktivasyonuna neden olmakta ve bu hastalarda normal popülasyona göre serum proinflamatuvar sitokinlerinin 10 kat daha yüksek olduğu bilinmektedir (1,14). Ayrıca, SDBY olan hastalarda akut faz birlikte görülmesi ise serum albümin seviyesinde oldukça büyük bir düşmeye neden olmaktadır (16,17). Bunun yanında HD ve PD esnasında görülen ekzojen kayıplar da hipoalbüminemiye yol açmaktadır.…”

Section: İnflamasyonunclassified

The Malnutrition-Inflammation-Atherosclerosis (MIA) Syndrom

Küçükkatırcı¹,

Şanlıer²

2016

Turk Neph Dial Transpl

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ÖzSon dönem böbrek yetmezliği (SDBY) olan hastalarda malnütrisyon, inflamasyon ve ateroskleroz gelişimi oldukça fazla görülmekte ve her bir parametre kendi başına mortalite ve morbidite oranını artırmaktadır. İlk olarak 2000 yılında ortaya atılan malnütrisyon-inflamasyon-ateroskleroz (MIA) sendromunun temelini, SDBY hastalarında serum proinflamatuvar sitokin düzeylerindeki artış ve bu hastalarda sıklıkla görülen malnütrisyon ve ateroskleroz arasındaki ilişki oluşturmaktadır. SDBY hastalarında proinflamatuvar sitokin seviyelerinin artmasıyla anoreksiyanın da arttığı ve bu durumun malnütrisyona zemin hazırladığı bilinmektedir. Aynı zamanda sitokin seviyelerindeki artışa bağlı olarak ortaya çıkan kronik inflamasyon hızlanmış ateroskleroza neden olabilmektedir. MIA sendromunun bileşenlerinin görülme oranının artmasıyla hastaların yaşam süreleri ve kaliteleri azalmaktadır. Bu nedenle derlemede; MIA sendromunun bileşenleri, bileşenlerin birbiriyle etkileşimi ve her bir bileşenle etkin mücadele etmek için izlenecek yollar hakkında bilgi vermek amaçlanmıştır.anahtar sözcükler: Böbrek yetmezliği, Malnütrisyon, İnflamasyon, Ateroskleroz, Beslenme durumu abStRact Development of malnutrition, inflammation and atherosclerosis are commonly seen in end-stage renal disease (ESRD) patients and the rates of mortality and morbidity are increased by each parameter. The basis of the malnutrition-inflammation-atherosclerosis (MIA) syndrome that has been proposed in 2000 for the first time is the relationship between increased serum levels of proinflammatory cytokine, malnutrition and atherosclerosis that are commonly seen in ESRD patients. The increase of proinflammatory cytokine levels in ESRD patients increases the anorexia and this is known to predispose to malnutrition. At the same time, it is reported that chronic inflammation due to elevated cytokine levels causes accelerated atherosclerosis. The life expectancy and quality of life of patients decreases with the increasing incidence of the components of the MIA syndrome. In this review, we aimed to explain the components of the MIA syndrome, the interactions of these components and effective treatment of each component.

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Serum Albumin as Predictor of Nutritional Status in Patients with ESRD

Cited by 164 publications

References 29 publications

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Subjective global assessment of the patients of chronic kidney disease undergoing dialysis

The Malnutrition-Inflammation-Atherosclerosis (MIA) Syndrom

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