Postdialysis albumin: a better nutrition marker in pediatric hemodialysis patients?

Abstract

Background Prehemodialysis serum albumin is considered an important indicator of nutritional status in pediatric hemodialysis (HD) patients. Study aim To determine whether serum albumin levels changed significantly from predialysis to postdialysis, and correlated with fluid changes over HD treatment. Methods We prospectively measured pre-HD and post-HD albumin levels in 9 pediatric patients (ages 10 to 20 years; mean age, 16.3 years) on HD over an 8-month period. Changes in weight and albumin over 45 HD treatments were compared. Results A total of 66.7% of pre-HD and 100% of post-HD albumin levels were within the normal range. Post-HD albumin was significantly higher than pre-HD in 42 of 45 observations (Mean, 4.7 ± 0.39 g/dL versus 3.8 ± 0.37; P < .0001). Δ albumin/treatment inversely correlated with weight loss ( r = 0.741, P < .0001) and prescribed ultrafiltration rate ( r = 0.764, P < .0001) Conclusions Serum albumin levels increase significantly postdialysis and inversely correlate with fluid removal. Pre-HD albumin level may not be a valid indicator of protein status because of the confounding effect of interdialytic weight gain, and may instead be a marker for fluid overload. Further studies are needed to assess the value of postdialysis albumin level as an indicator of nutritional status in pediatric HD patients.