Last update:
07-Jul-2004

OBJECTIVE Hypoalbuminemia is a common finding in chronic hemodialysis (HD) patients, mainly due to systemic inflammatory reaction (SIR), diminished protein intake and inadequate dialysis. This study constituted an attempt to define the causes of and their relative contribution to hypoalbuminemia in a population of dialysis patients in the area of West Attica and Piraeus.

METHOD 519 stable chronic HD patients (308 male, 211 female), with a mean age of 63.32±14 years and had been on hemodialysis for 47.8±44.46 months were studied. In these patients serum albumin, blood urea and C-reactive protein (CRP), as an index of the presence and severity of SIR, were determined before the dialysis session. In addition, blood urea was measured at the end of the same session and just before the next dialysis. In patients with daily urine output >400 mL, 24-hour urine urea was also measured. Finally, on the basis of the above urea measurements, delivered (D) Kt/V and normalized protein catabolic rate (nPCR), as index of daily protein intake, were estimated.

RESULTS In all the patients in the study, serum albumin levels were 3.76±0.46 g/dL (range 1.1–5.6 g/dL) while 103/519 patients (19.82%) presented with hypoalbuminemia (defined as serum albumin <3.5 g/dL). A statistically significant negative correlation of serum albumin with CRP (r=-0.471, P<0.001) was observed and, to a lesser degree, positive correlations with nPCR (r=0.252, P<0.001) and D Kt/V (r=0.205, P<0.001).

CONCLUSIONS In this study, 103/519 HD patients presented hypoalbuminemia which appeared to be caused mainly by the presence of SIR. Other contributing factors of minor importance seemed to be dietary protein intake and the adequacy of dialysis.

Key words: Hemodialysis, Hypoalbuminemia, Systemic Inflammatory Reaction (SIR).