Serum Albumin In Hemodialysis Patients Research Articles

Comparison of Llevel of improvement in serum albumin after protein supplementation verses standard treatment in patients on maintenance hemodialysis.

Background: Hemodialysis has been shown to increase protein catabolism and led to significant loss of proteins during hemodialysis. Hypoalbuminemia has been associated with adverse outcomes. Therefore, the main aim of this study is to determine the effect of intradialytic protein supplementation on serum albumin in hemodialysis patients.
 Methods: 116 hypoalbuminemic patients, as defined by the operational definition, on twice per week hemodialysis, from 15.09.15 to 15.03.16, were enrolled after obtaining informed consent. A non-randomized control trial was conducted after dividing the study population was divided into 2 groups; the study group which received 20g oral protein supplementation and the control group which have not received any supplementation. Outcome in terms of improvement in serum albumin was recorded on a predesigned proforma. SPSS version 17 was used for analysis. Effect modifiers were controlled by stratification. Chi square test was used to compare improvement in serum albumin between two groups and also after post stratification.
 Results: There were total 49 male and 67 female patients. Mean age of total patients was 57.25 years. 94.1% of the patients showed improvement in serum albumin in the intervention group and 56.9% in the control group. Patients of both genders between 46 to 75years, and those dialyzed for a shorter duration showed significant improvement in serum albumin levels.
 Conclusion: As intradialytic oral protein supplementation significantly improved serum albumin levels, specifically in elderly patients, it is therefore recommended to routinely administer nutritional supplements in hypoalbuminemic hemodialysis patients in order to reduce the overall mortality associated with hypoalbuminemia.

The efficacy and safety of zinc gluconate supplementation on quality of life, sleep quality, and serum albumin in hemodialysis patients: A randomized clinical trial

Hemodialysis patients suffer from several conditions, including low quality of life, poor sleep quality, and decreased serum albumin. We hypothesized that zinc supplementation may improve these problems. The aim of the present study was to examine the effects of zinc gluconate supplementation on quality of life, sleep quality, and serum albumin. In this parallel randomized clinical trial, 87 hemodialysis patients were randomly assigned in the zinc (n=44) or placebo group (n=43) for 12 weeks. Patients in the zinc group received one 30 mg zinc gluconate tablet per day. Quality of life was assessed The Kidney Disease Quality of Life (KDQOL) instrument, and sleep quality was evaluated by The Pittsburgh Sleep Questionnaire. Also, serum concentrations of albumin and high sensitivity C-reactive protein (hs-CRP) were measured at baseline and end of the study. There were beneficial effects of zinc supplementation on sleep quality (Effect (95% CI):-0.91(-1.34, -0.48)) and albumin concentration (Effect (95% CI): 0.327(0.06,0.59)), compared with placebo. However, we observed no changes in high-sensitivity C-reactive protein (Effect (95% CI): -6.59(-19.94,6.76)) and quality of life (Effect (95% CI): 0.17(-1.32,1.65) in zinc group in comparison with placebo. Also, we observed no adverse events from zinc supplementation in these patients. This randomized clinical trial showed that zinc supplementation elicited beneficial effects on sleep quality and albumin levels in hemodialysis patients. This randomized clinical trial was registered at IRCT.ir (IRCT20130903014551N10).

Aluminium and lead abnormalities in children on haemodialysis: relationship with some medications.

IntroductionThe determination of toxic elements in the biological samples of human beings is an important clinical procedure. This study was performed to investigate the prevalence of abnormal blood contents of 2 trace elements (TEs), aluminum (Al),and lead (Pb) in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3, Ca acetate, 1,25-dihydroxy vit. D3, and erythropoietin (EPO), as well as hematocrit level.Material and methodsWe included 43 patients on maintenance HD and they had continued the previously mentioned medications for at least 3 months. None of the patients were on Al containing phosphate binding agents.ResultsSerum aluminum and lead levels were significantly increased than in the healthy controls, but levels of both of them were far below toxic values. Male patients had higher mean levels of lead than did females. A strong positive correlation was found between serum Al and serum Pb levels among patients (r = 0.075, p = 0.0001).The serum level of Pb was positively correlated with the serum albumin in HD patients (r = 0.45, p = 0.03). Both serum aluminium and lead levels positively correlated with the EPO dose taken by the patients (r = 0.77, p = 0.0001 and r = 0.67, p = 0.0001 respectively).ConclusionsThe blood level of trace metals of these HD patients was not related to their medications except for the EPO dose. However, caution must be exercised in interpreting this result as dose and duration of medication may play an important role. Al and Pb over load may be considered from the causes of inadequate response to epoetin therapy.

All Oxidase Roads Lead to Angiotensin, Too

Free radicals and other oxygen- or nitrogen-derived reactive species formed during cellular metabolism and respiration, like superoxide (O2·−), hydrogen peroxide (H2O2), and nitric oxide (NO), are important second messengers and fundamental mediators in biological processes, redox signaling, and cellular growth. However, over the past 2 decades it has become clear that reactive oxygen species (ROS) in particular are also important participants in a number of pathological processes, including cardiovascular and kidney diseases. In fact, increased production of ROS has been proposed as a common pathomechanism by which cardiovascular risk factors affect the vessel wall to induce and amplify vessel and organ injury. See page 943 Several possible enzymatic sources of ROS have been identified in blood vessels and other tissues, such as nicotineamide adenine dinucleotide (phosphate) oxidase (NAD(P)H oxidase), xanthine oxidase (XO), and uncoupled nitric oxide synthase. NAD(P)H oxidase has long been considered one of the most important sources of ROS in the vessel wall. One of its most potent stimulants is angiotensin II. In turn, NAD(P)H oxidase mediates several downstream effects of angiotensin II like inflammation, endothelial dysfunction, collagen deposition, and vascular hypertrophy. Nevertheless, an important role in the pathogenesis of cardiovascular disease has also been ascribed to XO. This …

Inflammation and reduced albumin synthesis associated with stable decline in serum albumin in hemodialysis patients

The concentration of albumin in serum is maintained by its rates of synthesis, catabolism, and distribution between vascular and extravascular compartments. Albumin synthesis is suppressed when there is inflammation or inadequate protein intake. This study was conducted to establish whether a decline in serum albumin of >0.3 g/dL was accompanied by a change in albumin synthesis and if so whether these changes were associated with increased levels of acute phase proteins and/or with a decrease in equilibrated normalized protein catabolic rate (enPCR). Seventy-nine patients in the National Institutes of Health (NIH)-sponsored HEMO Study had baseline measurements of albumin synthesis (measured kinetically as the disappearance of [125]I human serum albumin), the serum concentrations of albumin, transferrin, C-reactive protein (CRP), alpha1 acid glycoprotein (alpha1AG), ceruloplasmin, interleukin-6 (IL-6), plus monthly measurements of enPCR. The plasma levels of all proteins and enPCR were measured regularly over 2 years or until serum albumin decreased by >0.3 g/dL on two sequential measurements. Albumin synthesis was measured a second time when serum albumin declined by >0.3 g/dL or after 2 years. Fifty-nine patients [21 with a significant decrease in serum albumin (decliners) and 38 with stable values of serum albumin] had albumin synthesis measured twice. A decline in albumin concentration and synthesis was associated with an increase in alpha1AG when data from all patients were analyzed as a group. In decliners, albumin synthesis decreased significantly but was unchanged in stable. Likewise, in decliners, IL-6, CRP, alpha1AG, and ceruloplasmin increased significantly but were unchanged in stable. enPCR was unchanged in both groups and was not associated with either changes in albumin level or synthesis in the whole group. A decrease in serum albumin of >0.3 g/dL that persists for a period of 6 weeks is associated a decrease in albumin synthesis. This response is associated with evidence of activation of the acute phase response (inflammation) but not with changes in enPCR. In well-dialyzed patients, inflammation is the principal cause of a decrease in serum albumin while protein intake plays an insignificant role.

Effects of simvastatin on high-sensitivity C-reactive protein and serum albumin in hemodialysis patients

A 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor is recommended in hemodialysis (HD) patients with hypercholesterolemia to improve their lipid profiles. We evaluated effects of simvastatin on markers for inflammation, oxidative stress, and coagulation in HD patients. Sixty-two maintenance HD patients with serum cholesterol levels of 200 mg/dL or greater were randomly assigned to the treatment group (n = 31; 8 men, 23 women; age, 63 ± 11 years) and administered simvastatin, 20 mg/d, for 8 weeks or to the control group (n = 31; 10 men, 21 women; age, 60 ± 12 years). We measured cholesterol, albumin, high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA; an index of lipid peroxidation), and D-dimer (a marker of intravascular coagulation) in blood at baseline and again at 8 weeks. Fifty-eight of 62 patients completed the study. In the control group, total cholesterol, serum albumin, hs-CRP, MDA, and D-dimer levels did not change. In the treatment group, simvastatin administration for 8 weeks significantly reduced total cholesterol levels from 232 ± 25 to 165 ± 39 mg/dL (P < 0.001) and hs-CRP levels from a median of 0.23 mg/dL (range, 0.05 to 1.63 mg/dL) to 0.12 mg/dL (range, <0.006 to 1.45 mg/dL; P < 0.01), whereas it increased serum albumin levels from 3.4 ± 0.3 to 3.6 ± 0.4 g/dL (P < 0.001). Administration of simvastatin did not affect MDA and D-dimer levels. These results suggest that in addition to the lipid-lowering effect, simvastatin had an antiinflammatory effect in HD patients. Considering that atherosclerosis is inflammation of the vascular wall, simvastatin may have a beneficial effect on cardiovascular disease, in part because it alleviates inflammation. © 2002 by the National Kidney Foundation, Inc.

Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients

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), alpha1 acid glycoprotein (alpha1 AG), or ceruloplasmin, and with nutritional markers, such as normalized protein catabolic rate (nPCR). To establish the relationship among parameters that regulate albumin levels and markers of nutrition and inflammation, we injected [125I]-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 alpha1 AG were measured weekly. Dialysate was collected during one dialysis each week to measure albumin loss. Results were analyzed by multiple linear regression. 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 alpha1 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 alpha1 AG and ceruloplasmin. Albumin concentration in dialysis patients changes with inflammation and nutritional status through their effects on albumin catabolism and synthesis, respectively. Within the range of albumin levels in these patients, nutritional variables primarily affected albumin synthesis while inflammation caused hypoalbuminemia by increasing albumin FCR. Albumin synthesis also increased in proportion to PV. The result of this is that PV expansion does not contribute to hypoalbuminemia.

Cross-sectional and longitudinal predictors of serum albumin in hemodialysis patients

Cross-sectional and longitudinal predictors of serum albumin in hemodialysis patients.BackgroundLower serum albumin concentrations predict increased mortality in hemodialysis (HD) patients. Many demographic, comorbidity, and modifiable treatment-related factors that predict HD patient outcomes may be associated with serum albumin.MethodsCross-sectional predictors of baseline albumin on December 31, 1993 were sought (N = 3981). Additional effects of the same baseline predictors on subsequent trends in albumin over one year were examined in a nested subsample of patients (N = 2245). Wave-1 of the United States Renal Data System Dialysis Morbidity and Mortality special study provided the data.ResultsSignificant associations (P < 0.05) are summarized as older age, female gender, peripheral vascular disease, chronic obstructive pulmonary disease, and cancer predicted a lower baseline albumin and negatively influenced subsequent albumin trends. Baseline albumin was higher for blacks (vs. whites), lower for smoking and diabetes, and lower during the first year of HD treatment (<3 months and 3 to 12 months, vs.> 1 year). Trend analysis showed more positive albumin slopes for patients in their first year on HD and more negative slopes for Native Americans (vs. whites). Baseline albumin was correlated with the type of vascular access being used [arteriovenous (AV) fistulas > AV grafts > permanent catheters > temporary catheters]. Trend analysis predicted more negative albumin slopes for AV grafts and permanent catheters (vs. AV fistula access). Baseline albumin correlated inversely with bicarbonate and directly with hematocrit. Dialysis with unmodified cellulose membranes, without reuse, predicted lower baseline albumin than the other membrane-reuse categories.ConclusionsSeveral exposures, which may be modifiable, were associated with serum albumin. Cross-sectional and longitudinal predictors of serum albumin in hemodialysis patients. Lower serum albumin concentrations predict increased mortality in hemodialysis (HD) patients. Many demographic, comorbidity, and modifiable treatment-related factors that predict HD patient outcomes may be associated with serum albumin. Cross-sectional predictors of baseline albumin on December 31, 1993 were sought (N = 3981). Additional effects of the same baseline predictors on subsequent trends in albumin over one year were examined in a nested subsample of patients (N = 2245). Wave-1 of the United States Renal Data System Dialysis Morbidity and Mortality special study provided the data. Significant associations (P < 0.05) are summarized as older age, female gender, peripheral vascular disease, chronic obstructive pulmonary disease, and cancer predicted a lower baseline albumin and negatively influenced subsequent albumin trends. Baseline albumin was higher for blacks (vs. whites), lower for smoking and diabetes, and lower during the first year of HD treatment (<3 months and 3 to 12 months, vs.> 1 year). Trend analysis showed more positive albumin slopes for patients in their first year on HD and more negative slopes for Native Americans (vs. whites). Baseline albumin was correlated with the type of vascular access being used [arteriovenous (AV) fistulas > AV grafts > permanent catheters > temporary catheters]. Trend analysis predicted more negative albumin slopes for AV grafts and permanent catheters (vs. AV fistula access). Baseline albumin correlated inversely with bicarbonate and directly with hematocrit. Dialysis with unmodified cellulose membranes, without reuse, predicted lower baseline albumin than the other membrane-reuse categories. Several exposures, which may be modifiable, were associated with serum albumin.

A comparison of cutaneous testing and ELISA testing for assessing reactivity to ethylene oxide-human serum albumin in hemodialysis patients with anaphylactic reactions

In five patients who have experienced anaphylaxis and in 29 patients who have not had such episodes during hemodialysis, we have performed two immunologic studies: cutaneous testing with ethylene oxide-human serum albumin (ETO-HSA) and ELISA for IgE against ETO-HSA. Four of five patients with reactions had positive cutaneous tests, whereas only one nonreactor had a positive skin test ( p < 0.0002). The same four of five patients with reactions also had positive ELISA results, whereas three nonreactors has positive ELISA results ( p < 0.003). In this group of patients, the positive predictive value of cutaneous testing (80%) is somewhat higher than that of ELISA testing (57%). However, the sensitivity, specificity, and negative predictive values are similar. We conclude that cutaneous testing with ETO-HSA probably offers a small advantage over IgE against ETO-HSA as determined by ELISA.