Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy?

Abstract

Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy? Serum albumin, transferrin, and prealbumin levels decrease as glomerular filtration rate (GFR) declines, even prior to the start of dialysis. The levels of these serum proteins are also associated with creatinine levels and lean body mass. Lean body mass also decreases with advancing renal failure. While all of these measures are regarded as reflections of nutritional status, each are strongly associated with any of several indicators of inflammation: positive acute-phase proteins or the cytokines that regulate their synthesis rate, in both longitudinal and cross-sectional studies. Inflammation in turn is associated with comorbid conditions, cardiovascular disease, chronic infections, age, and vascular access type. Additionally, dialysis patients are subjected to oxidative stress and exposure of blood to foreign antigens in the dialysis process that also potentially contribute to inflammation. In otherwise healthy individuals reduced protein and calorie intake does not cause hypoalbuminemia since albumin fractional catabolic rate (FCR) and resting energy expenditure (REE) normally decrease in response. The simultaneous occurrence of decreased protein intake and inflammation prevent these homeostatic compensations to reduced nitrogen and energy intake from occurring, resulting in decreasing albumin, transferrin, and prealbumin levels and loss of muscle mass. Nutritional intake may also be challenged as a result of renal failure associated with anorexia, gastroparesis, and socioeconomic factors, which may all cause nutritional intake to be sufficiently marginal so that the combined effects of inflammation and decrease protein intake are expressed as decreased visceral and somatic protein stores.

A Study of Inflammatory Status in Nephropathy Patients with History of Type-II Diabetes Mellitus Undergoing Haemodialysis

“…A positive correlation with r = 0.904 in Test Group-I and with r=0.946 in Test Group-II between Albumin and GFR signified that as the inflammatory process increased, there was a decrease in serum albumin due to its loss into the extravascular space which was caused by increased vascular permeability, its increased consumption by cells locally and its decreased synthesis as a result of its direct inhibition by cytokines [21]. This finding was comparable to the findings of Kaysen GA [22]. The correlation between CRP and Albumin increased with coefficients of correlation (r = -0.848 in Test Group-I and r= -0.78 in Test Group-II), with a negative trend, indicating a definite and a significant degree of an inverse relationship between the [Table/ Fig-2].…”

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

“…Color version available online DOI: 10.1159/000495150 moderate and severe malnutrition risk groups, lower than recommended levels for HD patients [21]. Mean BMI was in the overweight range (25-29.9 kg/m 2 ) in the minimal and moderate malnutrition risk groups but in the normal range (18.5-24.9 kg/m 2 ) in the mild and severe malnutrition risk groups [22].…”

Influence of Vascular Access Type on Outcome Measures in Patients on Maintenance Hemodialysis

“…The evaluation of albumin levels in ESRD patients on hemodialysis is complex [8, 19]. After initiation of dialysis, albumin levels increase in the first year among survivors, and are thought to be due partly to an improvement of the anorexia associated with renal failure, resulting in increased nutrition; and partly to the removal of uremic toxins that induces a pro-inflammatory state.…”