Bromcresol Purple Method Research Articles

Macronutrients, micronutrients intake and inflammation in hemodialysis patients

Inflammation in hemodialysis patients occurs since before undergoing hemodialysis. Inflammation is associated with an increase in oxidative stress. Hemodialysis patients are at risk for macronutrients and micronutrients deficiencies which can influence the increase in oxidative stress and inflammation. The purpose of this study was to evaluate the intake of micronutrients and inflammatory status in hemodialysis patients. This study was a cross-sectional study with 76 hemodialysis patients (40 male and 36 female) who attended in two hemodialysis centers of Kendal, Indonesia. After obtaining the written consent, then patients were interviewed food intake consisting of macronutrient and micronutrient intake. Macronutrient and micronutrient intake are obtained by the semi quantitative food frequency method and classified as a deficit (<100% adequacy level) and normal/ more (≥100% adequacy level), according to specific recommendations for individuals undergoing dialysis. Serum albumin was examined using the Brom Cresol Purple (BCP) method with a low category (<3.5 mg.dL-1) and normal (3.5 – 4.5 mg.dL-1). The hs-CRP serum was examined using the ELISA method and categorized as low (<1 mg.L-1), moderate (1 – 3 mg.L-1) and high (> 3 mg.L-1). A descriptive analysis was performed. The results of this study showed that 88.2% deficit energy intake, 84.2% deficit protein intake, 85.5% deficit of vitamin A intake, 85.5% deficit of vitamin C intake, 100% deficit of vitamin E intake, 98, 7% deficit zinc intake , 92.1% deficit copper intake. 63.2% subjects are low level of serum albumin and 61.8% subjects is high level of hs-CRP serum. Macronutrient and micronutrient intake in most hemodialysis patients shows deficit. The serum albumin of most hemodialysis patients shows low level. Serum hs-CRP most hemodialysis patients show high level.

METODE BROMCRESOL GREEN (BCG) DAN BROMCRESOL PURPLE (BCP) PADA SIROSIS HATI YANG MENDAPAT INFUS ALBUMIN

Albumin infusion is one of the therapeutic options in hypoalbuminemia patients. Serum albumin can be used to determine the albumininfusion therapy, prognosis and monitoring of liver cirrhosis. The time difference in measurement of serum albumin by bromcresol green(BCG) and bromcresol purple (BCP) methods can give different results. Serum albumin examination was done in 20 sera taken fromcirrhosis patients. Serum albumin was then evaluated before treatment, one (1) hour and 24 hours after the patient received an infusionof albumin and examined by bromcresol green (BCG) and bromcresol purple (BCP) methods. The serum albumin level by BCG methodincreased with a coefficient of 0.12 (p-value=0.022) with BCG method before (1.94±0.32 mg/dL) and after one (1) hour (2.06±0.32mg/dL) receiving intravenous albumin. The coefficient of albumin levels before and after 24 hours (2.12±0.38 mg/dL) was 0.18 (pvalue=0.07), whereas the increased levels of serum albumin after one (1) hour and after 24 hours of intravenous albumin, were notsignificant (p-value=0.467). The BCP method showed that serum albumin before, after one (1) hour and after 24 hours receivingintravenous albumin were 1.68±0.36 mg/dL, 1.87±0.36 mg/dL and 2.12±0.63 mg/dL respectively. The albumin levels showed asignificant increase before and after one (1) hour infusion of albumin (p-value=0.00), both levels shown before and after 24 hours(p-value=0.001), as well as one (1) hour and 24 hours after receiving intravenous albumin (p-value=0.04). The results of this studyshowed that increased serum albumin by BCG method could be detected after 1 (one) hour, whereas by BCP method could only be detectedafter 24 hours receiving intravenous albumin.

State of Harmonization of 24 Serum Albumin Measurement Procedures and Implications for Medical Decisions.

Measurements of serum and plasma albumin are widely used in medicine, including as indicators of quality of patient care in renal dialysis centers. Pools were prepared from residual patient serum (n = 50) and heparin plasma (n = 48) from patients without renal disease, and serum from patients with kidney failure before hemodialysis (n = 53). Albumin was measured in all samples and in ERM-DA470k/IFCC reference material (RM) by 3 immunochemical, 9 bromcresol green (BCG), and 12 bromcresol purple (BCP) methods. Two of 3 immunochemical procedures, 5 of 9 BCG, and 10 of 12 BCP methods recovered the RM value within its uncertainty. One immunochemical and 3 BCG methods were biased vs the RM value. Random error components were small for all measurement procedures. The Tina-quant immunochemical method was chosen as the reference measurement procedure based on recovery and results of error analyses. Mean biases for BCG vs Tina-quant were 1.5% to 13.9% and were larger at lower albumin concentrations. BCP methods' mean biases were -5.4% to 1.2% irrespective of albumin concentration. Biases for plasma samples were generally higher than for serum samples for all method types. For most measurement procedures, biases were lower for serum from patients on hemodialysis vs patients without kidney disease. Significant differences among immunochemical, BCG, and BCP methods compromise interpretation of serum albumin results. Guidelines and calculations for clinical management of kidney and other diseases must consider the method used for albumin measurement until harmonization can be achieved.

ALBUMIN SERUM DALAM SIROSIS HATI

Serum albumin measurement can be used for assessing prognosis, determining initial therapy and treatment efficacy for liver cirrhosis patients. The discrepancy result of albumin measurement using different methods can make bias for the albumin concentration. The measurement of albumin was carried out in 20 sera of liver cirrhosis patients using bromcresol green (BCG), BCG conversion as well as bromcresol purple (BCP) methods including protein electrophoresis. The results showed that BCP method has a lower albumin concentration than the other kind (1.68±0.35), BCG (1.94±0.31), BCG conversion (2.09±0.45) as well as protein electrophoresis (2.14±0.35). BCP method has a good correlation with protein electrophoresis as well as BCG conversion (r=0.935 and r=0.90 respectively). It can be concluded in this study, that albumin measurement with BCP method has a good correlation with protein electrophoresis. It is important to know that the measurement results of BCP method is lower but more accurate in the albumin concentration, because there is no cross reaction with globulin. That means, there is no overestimation of albumin concentration in hypoalbuminemia condition of the patients.

Sudden significant total protein concentration change: not an analytical problem

Sudden and significant total protein concentration changes in multiple myeloma (MM) can be associated with new treatment regimens. We present an example of a 66-year-old male with a total protein concentration of 74 g/L, albumin 27 g/L, and a monoclonal IgG concentration of 22.2 g/L before commencing lenalidomide treatment. The patient represented 8 days later and the total protein concentration was 66 g/L, albumin 32 g/L with a monoclonal IgG concentration of 10.3 g/L. The total protein and albumin measurements were performed on Beckman DxC800 analysers using bieuret and bromcresol purple methods, respectively (Beckman Coulter Diagnostics, Fullerton, CA). The IgG was performed on Beckman Image analyser (Beckman Coulter Diagnostics). It is regularly observed that patients with the new drug treatments have total proteins, more accurately the specific immunoglobulin decreasing significantly in a matter of days. Generally, the remaining biochemical profiles undergo minimal change. To laboratorians such a major significant change in total protein concentration will trigger alarms (including possibly delta check flags) of possible analytical errors: sampling accuracy or possible assay interference. This leads to additional investigations by laboratorians, which would include sample integrity checks (sufficient volume, microclots, bubbles), possible re-analysis, running additional quality control samples, changing total protein reagents, withholding of results until communication with other professionals including the clinical unit occur, and leading to delay in reporting of the results and added costs. MM is currently an incurable hematological malignancy. Monoclonal gammopathy, a common predisposing disease, occurs in 3% of persons 50 years of age or older (1). It is characterized by the clonal expansion of monoclonal immunoglobulin-secreting plasma cells within the bone marrow. The overall median survival for patients with MM without treatment is approximately 3 years. It is the second most common hematologic malignancy, and the most common cancer to involve bone. The cause of MM is unclear. Exposure to radiation, herbicides, insecticides, benzene, and other organic solvents may play a role. Until recently the standard treatment involved a combination of oral melphalan and prednisolone. Allogeneic transplantation was first attempted in the early 1980s, and it became routine therapeutic practice in the 1990s (2), but is not widely used due to high treatment-related mortality. Autologous stem cell transplant (ASCT) has become the treatment of choice. For patients unable to undergo ASCT, including elderly patients (465 years), or patients relapsing after ASCT there have been few treatment options. Singhal et al. in 1999 (3) indicated that thalidomide, an oral agent with anti-angiogenic and immunomodulatory properties, was able to induce objective responses in 30% of patients with refractory and advanced MM. In 2006, thalidomide was approved by the US FDA, and more recently lenalidomide (approved by FDA in 2006, European Union in June 2007), a thalidomide analog with up to 50,000-fold increased potency, (4) and bortezomib, a proteasome inhibitor (approved by US FDA in May 2003), have been added and used as salvage agents for the treatment of relapsed and refractory MM. Trials of these agents as frontline therapy are underway with very promising initial results. These new drugs are cytotoxic to MM cells in the bone marrow. Therefore, rapid and significant changes in total protein concentrations, globulin or specific immunoglobulin are expected.

Nachevaluierung des Referenzbereiches für Albumin im Serum/Plasma mit Farbstoffbindungsmethoden (Bromkresolgrün und Bromkresolpurpur) / Update of reference values for albumin in serum/plasma with bromcresol green or bromcresol purple methods

Zusammenfassung Der gebräuchliche Referenzbereich für die Farbstoffbindungsmethoden von Albumin nach Tietze (3,5–5,0 g/dL) ist für die mit ERM DA470k restandardisierte Albuminmethode mit Bromkresolgrün (BCG) nicht anwendbar. Die Untersuchung eines Blutspenderkollektivs (120 Proben) zeigte eine wesentliche Verschiebung des Medians und des 95%-Vertrauensbereiches für die neue Methode gegenüber der gegen humanes Serumalbumin standardisierten Albumin BCG Methode. Die Übereinstimmung mit der Albuminmethode mit Bromkresolpurpur (BCP) ist gut. Als Referenzintervall für das restandardisierte BCG-Verfahren sowie für das BCP-Verfahren wird für die Altersgruppe von 20 bis 60 Jahren für gesunde Personen ein Intervall von 3,0 g/dL bis 5,0 g/dL empfohlen.

The impact of the assay for measuring albumin on corrected ('adjusted') calcium concentrations

The K/DOQI guidelines recommend the use of albumin-corrected calcium (Ca), phosphate, parathyroid hormone (PTH) and calcium-phosphate product as therapeutic targets. The two most common assays for measuring albumin yield discordant results in uraemic patients, the Bromcresol purple (BCP) method providing lower albumin values than the Bromcresol green one (BCG). The aim of this study was to assess the impact of the assay on corrected Ca and, thus, on reaching recommended K/DOQI targets for corrected Ca and CaxP product. We measured plasma albumin (both by BCG and BCP), total Ca and phosphate in all our chronic hemodialysis (HD) patients. Total Ca was corrected ("adjusted") for albumin level by a formula proposed by the K/DOQI. 89 patients were included, aged 71.2 +/- 11.5 years, on chronic hemodialysis for 29 (1-362) months. Albumin level was 3.78 +/- 0.24 g/dL by BCG and 3.12 +/- 0.27 by BCP ( p < 0.0001). Based on BCG albumin levels there were 12 cases of "hypocalcaemia" (<8.6 mg/dL), 3 cases of "hypercalcaemia" (>10 mg/dL) and 74 cases with "normal" Ca. The corresponding albumin levels were 3.9 +/- 0.2; 3.1 +/- 0.6 and 3.8 +/- 0.2 g/dL, respectively. According to BCP albumin levels, only one patient was labelled as hypocalcaemia , 21 as hypercalcaemia et 67 as "normal" adjusted Ca (albumin 3.1; 3 +/- 0.3 and 3.2 +/- 0.3 g/dL, respectively). Depending on the use of BCG or BCP, a discrepancy was thus observed in 29 cases (32.6%): 18 cases were classified as hypercalcaemia when albumin was measured by BCP but were considered normal using BCG, whereas 11 cases classified as hypocalcaemia with BCG had normal adjusted Ca with BCP. Concerning CaxP product, 7 discrepancies were detected. The choice of either BCG or BCP has a major impact on albumin-adjusted Ca and thus on reaching K/DOQI targets for Ca and CaxP product. Clinicians should take this fact into account for the interpretation of laboratory values and the prescription of drugs related to mineral metabolism and dialysate calcium concentration. The type of assay used for the measurement of albumin should also be recorded and its impact taken into account (or corrected) in multicentric studies and registries.

Problems in serum albumin measurement and clinical significance of albumin microheterogeneity in cirrhotics

Objectives To clarify problems with the determination of serum albumin levels, the definition of hypoalbuminemia, and the implications of microheterogeneity of albumin, serum albumin was measured by using dye-binding methods and the authentic method (immunoassay) in patients with liver cirrhosis and healthy subjects. Methods We enrolled 103 patients with liver cirrhosis and 36 healthy subjects. Serum albumin levels were analyzed by immunoassay and the bromcresol green and bromcresol purple methods. Oxidized albumin and glycoalbumin were determined by high-performance liquid chromatography. Results In cirrhotic patients, serum albumin levels measured by the bromcresol green method was about 0.2 g/dL higher than that by immunoassay. Serum albumin levels measured by the bromcresol purple method also was higher in cirrhotic patients than those measured by immunoassay and varied widely. In addition, extensive variation was found across serum albumin levels determined by the bromcresol green method at individual institutions (five university hospitals) and those determined by immunoassay at a contract laboratory. The percentages of oxidized albumin and glycoalbumin within total serum albumin increased with progression of liver disease. Further, an increase in oxidized albumin led to an increase in the albumin level as measured by the bromcresol purple method. Conclusion These results show that adequate assessment of the pathophysiology and prognosis of patients with liver cirrhosis and the efficacy of treatment is not possible with dye-binding methods for determination of serum albumin. Further, the conventional definition of hypoalbuminemia as a serum albumin level of 3.5 g/dL or lower should be reconsidered, and the clinical implications of qualitative changes in albumin should be investigated in consideration of the microheterogeneity of albumin, such as oxidized albumin and glycoalbumin.

Improving albumin levels in peritoneal dialysis patients

Peritoneal dialysis patients with low albumin levels have been known to have an increased mortality risk.1Spiegel DM Breyer JA Serum albumin: A predictor of long-term outcome in peritoneal dialysis patients.Am J Kidney Dis. 1994; 23: 283-285PubMed Scopus (70) Google Scholar At the Renal Institute of the Pacific, Honolulu, Hawaii, low albumin levels among peritoneal dialysis patients are prevalent and a concern for renal dietitians. Nutrition intervention is needed in improving albumin levels and assisting peritoneal dialysis patients in optimizing their nutritional status. Renal dietitians at the Renal Institute of the Pacific have tailored nutrition education to specifically address the challenges of a multi-ethnic patient population that exists in Hawaii. The patient population is mainly comprised of Asian and Polynesian ethnicity with a local cuisine that reflects a unique blend of cultures. Dialysis patients, like many island residents, tend to eat more starchy foods, such as rice, noodles, and locally grown vegetables rather than protein foods. Canned and processed meat products, such as luncheon meat, corned beef, and sausage are commonly eaten in many households rather than fresh meat products because they are available and more economical. These convenience foods tend to contain less protein and are high in sodium and fat. An additional concern is that diabetic nephropathy is the leading cause of renal failure in Hawaii, with rates exceeding 52% among dialysis patients.2Transpacific Renal Network: Selected Demographics 1999. San Rafael, CA, pp 21Google Scholar Diabetic patients on continuous ambulatory peritoneal dialysis have been shown to have a higher incidence of mild to moderate malnutrition than nondiabetic patients.3Young GA Kopple JD Lindholm B et al.Nutritional assessment of continuous ambulatory peritoneal dialysis patients: An international study.Am J Kidney Dis. 1991; 17: 462-471PubMed Scopus (421) Google Scholar Because of this, renal dietitians are faced with the need to create innovative educational materials. The Peritoneal Dialysis Nutrition, Improving Your Albumin Level handout was developed and used in combination with verbal instructions during the counseling session. The handout defines albumin and emphasizes the importance of adequate protein consumption and ways to stay well. It was individualized to meet each patient's own nutrient needs. Following the counseling session, knowledge and understanding of the patient was evaluated using Albumin Quiz! It consisted of questions on albumin and on the identification of local foods high in protein. Patients were also asked to demonstrate their daily protein serving requirements using food models that depicted local protein foods. When these educational materials were presented to 32 peritoneal dialysis patients with low and marginal albumin levels, intervention seemed to be effective. In the following 2 months, average albumin levels using the bromcresol purple method improved from 2.98 g/dL to 3.08 g/dL and nutrition knowledge increased. The protein serving size demonstration was also found to be beneficial in reinforcing appropriate servings to meet individual daily needs. The authors would like to thank Roberta Lovely, RN, MPH, Administrative Director, and the dietitians at the Renal Institute of the Pacific, Honolulu, Hawaii.

Discrepancies in Serum Albumin Measurements Vary by Dialysis Modality

Background. Serum albumin level is an important prognostic marker in patients with chronic renal failure. However there are discrepancies in the methods of estimation of serum albumin. The objective of this study is to evaluate the magnitude of the discrepancy in the serum albumin levels as measured by Bromcresol Green (BCG) and Bromcresol Purple (BCP) dye methods in patients on hemodialysis (HD) and peritoneal dialysis (PD) and to ascertain the clinical determinants of the discrepancy (ΔSA = BCG-BCP; g/dL) in each of the modalities. Method. We measured serum and plasma albumin levels by BCG and BCP methods in 19 adult HD patients and 18 adult PD patients treated in the dialysis units of the University of Colorado Health Sciences Center. Similar measurements were performed in 10 normal adult subjects. In all groups, paired blood samples were taken to estimate the albumin in both serum and plasma. Nephelometry (NM) was subsequently performed on the serum of 13 of the HD patients, 14 of the PD patients, and each of the 10 normal subjects. Results. We found that for both the dye methods serum and plasma albumin levels are almost identical in each of the three subject groups. In the normal subjects serum albumin estimated by BCP is in good agreement with NM values but BCG overestimates the albumin levels. In the PD group the discrepancy between the BCG and BCP (ΔSA) is statistically significant with the BCG averaging 0.59 ± 0.12 g/dL more than the BCP. The BCG values are closer to those obtained by the “gold standard”, NM. In the HD group the ΔSA is significantly (p<0.001) less than in the PD group (0.34 ± 0.11 g/dL). As for PD, BCG values are closer to NM values. Increasing age, female gender, and higher dialysis adequacy are associated with higher ΔSA in the HD but not in the PD group. Utilizing linear regression analysis we developed equations for each dialysis modality to convert albumin measurements from one method to the other. Conclusion. We confirm that a discrepancy exists between the commonly used dye methods (BCG and BCP) for serum albumin estimation. This discrepancy is significantly lower in HD patients than in PD patients. Nephrologists should be aware of this discrepancy and appropriate corrections should be made during quality improvement analysis.

Duration of dialysis and its relationship to dialysis adequacy, anemia management, and serum albumin level

An analysis of the relationship between intermediate outcomes and duration of dialysis therapy in hemodialysis patients was performed by linking Health Care Financing Administration (HCFA) Core Indicators data with data obtained from HCFA form 2728 at the initiation of dialysis therapy. Patients who recently initiated hemodialysis therapy were less likely to meet Dialysis Outcomes Quality Initiative guidelines than patients with a longer duration of dialysis therapy. For both urea reduction ratio and Kt/V, odds ratios for adequate dialysis were approximately 0.20 for a duration of dialysis therapy less than 0.5 years and 0.42 to 0.63 for a duration of dialysis therapy of 0.5 to 1.0 years compared with a duration of dialysis therapy of 2.0 years or greater. For patients with a duration of dialysis therapy less than 0.5 years (compared with >2.0 years), the odds ratio for a hematocrit less than 28% was approximately 3.0, that for a hematocrit 33% or greater was approximately 0.6, and that for a serum albumin level of 3.5 g/dL or greater (bromcresol green method) or 3.2 g/dL or greater (bromcresol purple method) was approximately 0.4. There was a direct relationship between glomerular filtration rate at the initiation of dialysis therapy and both serum albumin and hematocrit values. Patients administered recombinant human erythropoietin (rHuEPO) predialysis were more likely to have greater hematocrits. There also was a direct relationship between hematocrit and serum albumin level. Therefore, several actionable items in regard to attentive overall medical care can result in an improvement in the percentage of patients newly started on hemodialysis therapy who meet intermediate outcomes, including the administration of rHuEPO predialysis, correction of iron deficiency, and timely placement of a permanent dialysis access. © 2001 by the National Kidney Foundation, Inc.

Can a Nutrition Intervention Improve Albumin Levels Among Hemodialysis Patients? A Pilot Study

To determine the effect of a tailored intervention on albumin levels among hemodialysis patients. Randomized controlled trial. Eight freestanding chronic hemodialysis units in northeast Ohio. Eighty-three randomly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin <3.7 g/dL (bromcresol green method) or <3.4 g/dL (bromcresol purple method) for the last 3 months. To better elucidate the feasibility and outcomes of the intervention, we selected more intervention than control patients. Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient: (1) poor knowledge of protein-containing foods, (2) poor appetite, (3) needing help shopping or cooking, (4) low fluid intake, and (5) inadequate dialysis. Depending on the specific barriers present, the dietitians (1) educated patients on protein-containing foods, (2) recommended snacks for which patients had preserved appetite, (3) helped set up social supports, (4) provided recommendations on fluid intake, and/or (5) arranged for improved dialysis. Dietitians of the 31 control patients continued to provide usual care. Change in albumin after 6 months, stratified as minimal change (less than.25 g/dL increase or decrease), moderate improvement (.25 to.49 g/dL increase), and large improvement (increase of .50 g/dL or more). To examine the role of inflammatory states, we also determined serum C-reactive protein levels at the beginning and end of the trial. Among intervention patients, 29% had a minimal change in albumin, 44% had a moderate improvement, and 27% had a large improvement. Among control patients, 74% had a minimal change in albumin, 19% had a moderate improvement, and 6% had a large improvement (P <.001 for comparison of intervention and control subjects). About 60% of subjects had high baseline C-reactive protein levels (> 10 mg/L). However, there was little relationship between change in albumin and either baseline C-reactive protein levels or changes in C-reactive protein levels (P = .83). A nutrition intervention tailored to patient-specific barriers resulted in improved albumin levels even among patients with high C-reactive protein levels. Further work is needed to refine and test this intervention on a larger sample.

Reduction of reaction differences between human mercaptalbumin and human nonmercaptalbumin measured by the bromcresol purple method

Although the bromcresol purple (BCP) method provides high specificity in measurements of serum albumin concentrations, we discovered a reaction difference between the values for human mercaptalbumin (HMA) and human nonmercaptalbumin (HNA) measured by the BCP. We found that the color intensity of HMA with BCP present in the reduced form in the albumin of fresh serum, was lower than for HNA. While maintaining specificity for albumin, we reduced the reaction difference between HMA and HNA, with the addition of sodium dodecylsulfate and 5,5′-dithiobis(2-nitrobenzoic acid) to the BCP reagent. The mean albumin concentration by the BCP procedure for 63 fresh sera and the 63 sera stored for 2 days at room temperature were 35.6 g/L and 38.1 g/L, respectively. Those by the modified BCP procedure were 39.8 g/L and 39.9 g/L, respectively. The difference in measured values between the fresh and stored sera which is believed to be caused by the conversion of HMA to HNA during the storage of sera was not observed in the case of the modified BCP procedure. Our modified BCP method is effective in eliminating uncertainty of the albumin concentration assigned to assay calibrators for the conventional BCP method.

Report from the 1995 Core Indicators for Peritoneal Dialysis Study Group

The 1995 Peritoneal Dialysis Core Indicators Study was conducted by the Health Care Financing Administration to ascertain standard practices and outcomes in chronic peritoneal dialysis patients. Data from 1,202 patients who did not receive hemodialysis but who were on chronic ambulatory peritoneal dialysis (CAPD) for at least part of the 6-month period between November 1, 1994, and April 30, 1995, are reported. The mean serum albumin level for this cohort was 3.5 g/dL by the bromcresol green method and 3.2 g/dL by the bromcresol purple method. Data sufficient to calculate a weekly Kt/V urea or weekly creatinine clearance were available for only 34% of patient submissions. In these patients, the median weekly Kt/V urea was 1.7 using a fixed value for V of 0.58 × body weight and was 2.0 using the Watson equation to calculate V, the median weekly creatinine clearance was 60.7 L/wk/1.73 m 2. The mean hematocrit for this cohort was 32% and the average weekly recombinant human erythropoietin (rHmEPO) dose was 115 μ/ kg. Hematocrit values ≤30% were found in 50% of black patients and 31% of white patients. The average blood pressure among peritoneal dialysis patients was 139/80 mm Hg, with 29% of patients having a systolic blood pressure exceeding 150 mm Hg and 18% a diastolic blood pressure greater than 90 mm Hg. In summary, serum albumin levels were significantly lower in peritoneal dialysis patients than in hemodialysis patients. Approximately one third of peritoneal dialysis patients did not have an adequacy measure obtained during the 6-month observation period. A significant minority of patients had either inadequately treated anemia of chronic renal disease or hypertension. There is an opportunity to substantially improve the medical care provided to chronic peritoneal dialysis patients.

Albumin and Amino Acid Levels as Markers of Adequacy in Continuous Ambulatory Peritoneal Dialysis

Similar to previous findings in HD patients, a markedly decreased serum albumin level has been found to be a strong predictor of morbidity and mortality in CAPD patients. However, a slight decrease in serum albumin levels (to about 30 g/L if measured with nephelometry or the bromcresol purple method) does not always seem to reflect impaired nutritional status or to be associated with an increased morbidity or mortality in CAPD patients. A low serum albumin level among CAPD patients is related to dialysate albumin loss, comorbidity, age, and a low dietary protein intake. The possible relation between the dialysis dose (as assessed by small solute clearances) and serum albumin levels among CAPD patients is much less established and needs further study, although serum albumin tends to increase in prospective studies of increased peritoneal dialysis dose. Although the plasma levels of amino acids seem to be lower in CAPD patients compared to HD patients, this does not reflect the intracellular amino acid pattern in muscle which is less abnormal in CAPD patients, possibly because of the sustained hyperinsulinemia during CAPD, resulting in an increased intracellular to extracellular gradient. It is at present not established to what extent the amino acid abnormalities are related to the dialysis dose. Malnourished and hypoalbuminemic CAPD patients should be recommended to increase the protein intake, and if this is not effective, the dialysis dose should be increased. Furthermore, the use of amino acid-based peritoneal dialysis solutions is a promising new tool for the treatment of malnourished CAPD patients and may become an important component of CAPD therapy in the future. On the other hand, if the nutritional status deteriorates in spite of these efforts, the patient should be transferred to hemodialysis if possible.

Serum Albumin Concentration-Related Health Care Financing Administration Quality Assurance Criterion Is Method-Dependent: Revision Is Necessary

The objective of this study was to examine quantitative differences between the two commonly used methods for determining serum albumin concentration, bromcresol green (BCG) and bromcresol purple (BCP), in normal subjects and in 235 unselected dialysis patients in view of recently established Health Care Financing Administration (HCFA) quality assurance review criteria. The mean of normal results by the BCG method was 4.4 g/dL, and 97.5% of values were 3.8 g/dL or higher. The mean of normal results by the BCP method was 3.9 g/dL, and 97.5% of values were 3.3 g/dL or higher. Serum albumin concentrations in samples from the dialysis patients had respectively lower mean values by both methods. For the BCG method, the mean was 3.8 g/dL, and 82% of values were 3.5 g/dL or higher; for the BCP method, the mean was 3.3 g/dL, and 82% of values were 3.0 g/dL or higher. Likewise, for the reference immunonephelometric procedure, the mean value for the dialysis patients was 3.3 g/dL, and 82% of values were 3.0 g/dL or higher. For the samples from the dialysis patients, in comparison with the immunonephelometric method, the BCG method exhibited both constant (intercept = 9.3 g/L) and proportional error (slope = 0.87). The mean albumin value for the BCG method was 3.8 g/dL, 15% higher. In contrast, the BCP method compared closely with the reference method: slope = 1.00, intercept = 0.8 g/L, mean x = 3.3 g/dL, mean y = 3.3 g/dL. The HCFA quality assurance criteria are valid only for the BCG method.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of serum-isolated vs synthetic bilirubin-albumin complexes on dye-binding methods for estimating serum albumin

Bush and Reed reported (Clin Chem 1987;33:821-3) that the reaction of albumin with bromcresol purple but not with bromcresol green underestimated the concentration of albumin in synthetically obtained bilirubin-albumin (Bd) by 29%. Their unproven assumption was that chemically synthesized Bd behaved in a manner indistinguishable from the natural Bd in icteric serum. Here we verify that Bd, whether synthetically obtained or isolated from serum, causes an underestimation of albumin in the bromcresol purple but not in the bromcresol green method. The molar ratio of Bd from either source to underestimated albumin approximates 1.0, suggesting that one molecule of Bd would react equivalently to a molecule of albumin in the bromcresol purple method. This underestimation might falsely suggest hypoalbuminemia in patients with increased serum Bd.

Increase of Albumin Concentration Measured by Bromcresol Purple Method During Storage of Serum

Increase of Albumin Concentration Measured by Bromcresol Purple Method During Storage of Serum

Underestimation of serum albumin by the bromcresol purple method and a major endogenous ligand in uremia

In hemodialyzed patients, the serum albumin concentration determined by the bromcresol purple (BCP) method was lower than that determined by an immunological method. The degree of underestimation appeared to be well correlated to the serum concentration of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), a major endogenous ligand substance present in urémie serum. CMPF inhibited in vitro the binding of BCP to serum protein and human serum albumin. Our results suggest that CMPF is a major interfèrent in the underestimation of the serum albumin concentration by the BCP method in uremia.

A bromcresol purple method for measuring albumin in the "Monarch" centrifugal analyzer.

A bromcresol purple method for measuring albumin in the "Monarch" centrifugal analyzer.