We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients.
- Authors
Kaysen, George A; Dubin, Joel A; Müller, Hans-Georg; Mitch, William E; Rosales, Laura M; Levin, Nathan W; the Hemo Study Group
- Abstract
Background. Serum albumin concentration is a balance among its synthesis rate, fractional catabolic rate (FCR), distribution, dilution in the plasma pool and external loss. The physiologic bases for establishing the level of serum albumin in hemodialysis patients have not been defined despite the association of hypoalbuminemia with excess mortality. Albumin concentration is associated with the levels of several acute phase proteins (APPs), C-reactive protein (CRP), αl acid glycoprotein (αl AG), or ceruloplasmin, and with nutritional markers, such as normalized protein catabolic rate (nPCR). Methods. To establish the relationship among parameters that regulate albumin levels and markers of nutrition and inflammation, we injected [[sup 125]I]-albumin, into 64 hemodialysis patients enrolled in the HEMO study to measure albumin distribution, synthesis and FCR. These variables were related to the levels of acute phase proteins (APPs), nPCR, body mass index (BMI), external albumin loss as well as demographic variables. Albumin distribution, synthesis and FCR were calculated from kinetic modeling, as was the initial plasma volume (PV). Serum albumin, transferrin, CRP, ceruloplasmin and αl AG were measured weekly. Dialysate was collected during one dialysis each week to measure albumin loss. Results were analyzed by multiple linear regression. Results. Albumin concentration correlated with its synthesis rate and FCR, but not with PV or its distribution between the vascular and extravascular pools. Albumin concentration also correlated with nPCR and αl AG. However, albumin synthesis was directly related most strongly to PV and BMI (or nPCR), but not to levels of APPs. By contrast, albumin FCR correlated positively with both αl AG and ceruloplasmin. Conclusion. Albumin concentration in dialysis patients changes with inflammation and nutritional status through their effects on albumin catabolism and synthesis, respectively. Within the range...
- Subjects
KIDNEYS; NUTRITION; PHYSIOLOGY; ALBUMINS; HEMODIALYSIS; INFLAMMATION
- Publication
Kidney International, 2002, Vol 61, Issue 6, p2240
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.2002.00076.x