Albumin and renal transplant outcome

Abstract

Hypoalbuminemia is a feature of a number of chronic disorders. Children with chronic kidney disease (CKD) have a number of reasons for low serum albumin: urinary losses, nutritional deficiencies, and chronic inflammation. Indeed, for many children with CKD, all three mechanisms are operative.In many conditions, including CKD, hypoalbuminemia is a useful predictive marker of poor outcome. In this issue of The Journal, Butani et al studied a national database of children undergoing kidney transplants to determine if low serum albumin was a marker for poor transplant outcome. Because many children with hypoproteinemia undergoing kidney transplants have nephrotic disorders with a propensity to recur in the new organ, their conclusion that low serum albumin at the time of listing for transplantation is a risk for graft failure is not surprising. However, even when controlling for the underlying cause of CKD, the predictive value of hypoalbuminemia for graft failure remained. It is very reasonable to hypothesize that ongoing chronic inflammation may be a major contributor to this.Although no clear “action item” can be drawn from this study, it does raise the serious question as to whether transplant may better be delayed in the face of low serum protein. The authors show that there already is wide regional variation in the practice of transplanting children with hypoalbuminemia, suggesting that some practitioners may already be taking such an approach.Article page 602▶ Hypoalbuminemia is a feature of a number of chronic disorders. Children with chronic kidney disease (CKD) have a number of reasons for low serum albumin: urinary losses, nutritional deficiencies, and chronic inflammation. Indeed, for many children with CKD, all three mechanisms are operative. In many conditions, including CKD, hypoalbuminemia is a useful predictive marker of poor outcome. In this issue of The Journal, Butani et al studied a national database of children undergoing kidney transplants to determine if low serum albumin was a marker for poor transplant outcome. Because many children with hypoproteinemia undergoing kidney transplants have nephrotic disorders with a propensity to recur in the new organ, their conclusion that low serum albumin at the time of listing for transplantation is a risk for graft failure is not surprising. However, even when controlling for the underlying cause of CKD, the predictive value of hypoalbuminemia for graft failure remained. It is very reasonable to hypothesize that ongoing chronic inflammation may be a major contributor to this. Although no clear “action item” can be drawn from this study, it does raise the serious question as to whether transplant may better be delayed in the face of low serum protein. The authors show that there already is wide regional variation in the practice of transplanting children with hypoalbuminemia, suggesting that some practitioners may already be taking such an approach. Article page 602▶ Pretransplant Serum Albumin Is an Independent Predictor of Graft Failure in Pediatric Renal Transplant RecipientsThe Journal of PediatricsVol. 164Issue 3PreviewTo determine the prevalence of hypoalbuminemia in children listed for renal transplantation and to evaluate the effect of pretransplant hypoalbuminemia on posttransplant outcomes. Full-Text PDF