Hypoalbuminemia seems to be associated with a higher rate of hospitalization in hemodialysis patients

Antunes, Sandra Azevedo; Canziani, María Eugênia Fernandes; Campos, Arnon Farias; Vilela, Rosana Quintela Brandão

doi:10.5935/0101-2800.20160011

Cited by 12 publications

(14 citation statements)

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“…We observed that age was negatively associated with the ERI. While it seems counterintuitive that older patients show a better response to αEPO treatment, similar results are consistently found in other studies evaluating hemodialysis patients ( 3 , 20 , 25 – 27 ). We also observed a negative association between serum levels of albumin and the ERI, that is, an increase in albumin enhanced the response to αEPO.…”

Section: Discussionsupporting

confidence: 85%

Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

Santos

Hortegal²,

Serra

et al. 2018

Braz J Med Biol Res

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Anemia is an inevitable complication of hemodialysis, and the primary cause is erythropoietin deficiency. After diagnosis, treatment begins with an erythropoiesis-stimulating agent (ESA). However, some patients remain anemic even after receiving this medication. This study aimed to investigate the factors associated with resistance to recombinant human erythropoietin therapy with epoetin alfa (αEPO). We performed a prospective, longitudinal study of hemodialysis patients receiving treatment with αEPO at our reference hospital from July 2015 to June 2016. Clinical data was collected, and the response to αEPO treatment was evaluated using the erythropoietin resistance index (ERI). The ERI was defined as the weekly weight-adjusted αEPO dose (U/kg per week)/hemoglobin level (g/dL). A longitudinal linear regression model was fitted with random effects to verify the relationships between clinical and laboratory data and ERI. We enrolled 99 patients (average age, 45.7 (±17.6) years; male, 51.5%; 86.8% with hypertension). The ERI showed a significant positive association with serum ferritin and C-reactive protein, percentage interdialytic weight gain, and continuous usage of angiotensin receptor blocker (ARB) hypertension medication. The ERI was negatively associated with serum iron and albumin, age, urea reduction ratio, and body mass index. Our findings indicate that resistance to αEPO was related to a low serum iron reserve, an inflammatory state, poor nutritional status, and continuous usage of ARBs.

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Section: Discussionsupporting

confidence: 85%

Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

Santos

Hortegal²,

Serra

et al. 2018

Braz J Med Biol Res

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“…Serum albumin level is an important marker for nutritional status. (23) Malnourished patients present poorer overall health dimensions, with a decrease in physical and mental aspects, and a higher prevalence of symptoms. (23,24) Anemia worsens the HRQoL of hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

“…(23) Malnourished patients present poorer overall health dimensions, with a decrease in physical and mental aspects, and a higher prevalence of symptoms. (23,24) Anemia worsens the HRQoL of hemodialysis patients. A low serum hemoglobin level has been independently associated with decreased MCS, low social and emotional function, worsening of physical function, and limitation in work and daily activities.…”

Section: Discussionmentioning

confidence: 99%

“…A low serum hemoglobin level has been independently associated with decreased MCS, low social and emotional function, worsening of physical function, and limitation in work and daily activities. (23) The adjustment of anemia through the use of erythropoietin has improved HRQoL of these patients. (25) The number of prescribed medications is an independent predictor of lower scores on the physical dimensions of the HRQoL of patients in hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

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Qualidade de vida relacionada à saúde de pacientes em terapêutica hemodialítica

Pereira

Leite

2019

Acta paul. enferm.

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Resumo Objetivo identificar e mensurar fatores associados à qualidade de vida relacionada à saúde de pacientes renais crônicos em hemodiálise e analisar a associação da qualidade de vida relacionada à saúde e a adesão ao regime terapêutico hemodialítico. Métodos Estudo transversal com 258 pacientes em terapia hemodialítica. Avaliou-se a qualidade de vida relacionada à saúde através do questionário Kidney Disease Quality of Life Short Form. Foram analisados os componentes específicos da doença renal crônica e os componentes sumarizados físico e mental. A análise da não adesão ao regime terapêutico hemodialítico teve como base os indicadores do estudo The Dialysis Outcomes and Practice Patterns Study. Utilizaram-se, para a análise os testes de Mann Whitney e Kruskal Wallis. Resultados Indivíduos do sexo feminino, com menos de 60 anos, brancos, baixo nível socioeconômico, que necessitam de acompanhante, em terapia hemodialítica por menos de 5 anos, que possuem prescrição medicamentosa com dez ou mais fármacos, com baixos níveis séricos de albumina e hemoglobina e que não aderiram à restrição hídrica e à terapia apresentaram piora na qualidade de vida relacionada à saúde. Conclusão A avaliação da qualidade de vida relacionada à saúde dos pacientes em hemodiálise apresentou associação com as características sociodemográficas, clínicas e terapêutica. A monitoração desses parâmetros, bem como a busca do alcance dos padrões recomendáveis poderão subsidiar a prática clínica, aprimorar o planejamento assistencial e trazer melhorias em diversos aspectos da vida dos pacientes.

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“…Among these, 76.6% had albumin < 3.8 g/dL but BMI ≥23 kg/m 2 and 14.9% had both BMI < 23 kg/m 2 and albumin < 3.8 g/dL, indicating that low serum albumin was present in 91.5% of individuals with any elevated malnutrition risk and 42.3% of the total study population. Hypoalbuminemia was identified in 63% of Brazilian HD patients and emerged as the only independent predictor of hospitalization, while anemia and inflammation did not predict this outcome in a multicenter, crosssectional survey [27]. Reduced visceral and somatic protein stores were identified in a large cohort of US HD patients: approximately 41% had serum albumin < 3.5 g/ dL, and 31% had both hypoalbuminemia and serum creatinine < 6 mg/dL [28].…”

Section: Discussionmentioning

confidence: 99%

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Boaz

Azoulay

Schwartz

et al. 2019

Nephron

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Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

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Hypoalbuminemia seems to be associated with a higher rate of hospitalization in hemodialysis patients

Abstract: The presence of hypoalbuminemia, but not anemia or inflammation, was able to predict hospitalization in hemodialysis patients.

Cited by 12 publications

References 0 publications

Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

Qualidade de vida relacionada à saúde de pacientes em terapêutica hemodialítica

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

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