Prevalence of low albumin, suboptimal energy, and muscle stores in Asian dialysis patients

Abstract

Objective: Investigate the prevalence of low serum albumin levels (<3.2 g/L) and decreased arm muscle area percentiles and arm fat area percentiles in Asian patients compared with non-Asian patients treated with dialysis. Design: Cross-sectional study in which serum albumin and anthropometric measurements were averaged over 6 months, and compared between patients of Asian ethnicity and patients of non-Asian ethnicity. Setting: Eight outpatient dialysis facilities. Subjects: Ninety-seven Asian and 513 non-Asian patients treated with hemodialysis or peritoneal dialysis. Results: Height, weight, and body mass index were significantly lower in Asians compared with non-Asians ( P < .001). Protein catabolic rate was significantly greater in Asian (1.17 ± 0.29 g/kg) compared with non-Asian (0.97 ± 0.28 g/kg) women ( P < .001). Asian men (3.30 g/dL) and women (3.26 g/dL) had lower serum albumin compared with non-Asian men (3.35 g/dL; P = .057) and women (3.34 g/dL; P = .040). The proportion of patients with serum albumin <3.2 g/dL was greater for both Asian women (35%) ( P < .040) and men (30%) than non-Asian women (25%) and men (20%). After adjusting for important covariates, serum albumin remained significantly different between Asian and non-Asian patients ( P < .05). The proportion below the fifth percentile for arm muscle area was significantly greater for both Asian men (54%) and women (19%) compared with non-Asian men (24%) and women (8%). Proportions of Asian and non-Asian women below the 10th and 5th percentile for arm fat area were similar. However, Asian men (54%) had a significantly greater fat depletion than non-Asian men (26%). Conclusion: Mean serum albumin was significantly lower in Asian patients on dialysis than in non-Asians. Muscle stores were depleted in Asian men and women compared with non-Asians, and fat stores were depleted in Asian men. Based on this study, Asian dialysis patients would seem to be at higher nutritional risk than non-Asians, particularly Asian men. Further research is needed to assess factors that affect serum albumin and mortality in Asian dialysis patients, and standards need to be developed to further assess anthropometric measurements in this population.