Serum Albumin, Body Weight and Inflammatory Parameters in Chronic Hemodialysis Patients: A Three-Year Longitudinal Study

Abstract

Backgrounds and Aims: The present study aimed at making prospective longitudinal measurements of nutritional and inflammatory parameters to determine whether nutritional and inflammatory status decline or increase over time in a cohort of prevalent hemodialysis patients, and to evaluate which factors influence eventual changes. Patients: 64 hemodialysis patients were followed at 0, 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, and 36 months. At each follow-up visit, dry body weight, serum albumin, serum total cholesterol, total white blood cells, total lymphocyte count, serum glucose, C-reactive protein, ferritin, fibrinogen, hemoglobin, and weekly erythropoietin dose were assessed. Main Outcome Measures: Changes in nutritional and inflammatory parameters over time. Results: 43 patients completed the study at 36 months. Mean serum albumin levels (g/dl) improved significantly between baseline (3.76 ± 0.24) and 36 months (3.93 ± 0.27) (F = 4.005; p = 0.0009). Dialytic age was significantly associated with changes of serum albumin (F = 2.797; p = 0.028). The mean dry weight slightly remained stable over time (F = 1.473; p = 1.0) as well as the level of total cholesterol (p = 0.77) and lymphocyte count (F = 1.539; p = 0.186). Over time, the levels of C-reactive protein tended to decrease, although the differences were not statistically significant (F = 1.332; p = 0.19). Over time, the serum level of fibrinogen (F = 0.422; p = 0.17) and ferritin (F = 0.314; p = 0.52) remained stable. The number of white blood cells significantly decreased over time (F = 4.691; p = 0.0079) and dialytic age (F = 3.214; p = 0.015) was the variable significantly associated with such decline. The hemoglobin levels (F = 1.423; p = 0.14) and the weekly erythropoietin dose did not change significantly during the study (F = 1.019; p = 0.61), nor did the serum glucose levels (F = 1.231; p = 0.10). Conclusion: These results support the hypothesis that end-stage renal disease and HD are not necessarily associated with deterioration of the nutritional status over time.

Serum Albumin as Predictor of Nutritional Status in Patients with ESRD

“…Whereas serum albumin was a weak predictor of nutritional status defined by SGA score, associations between serum albumin and other markers of nutritional status, such as handgrip strength and LBM, were even weaker. Our data showing this clear lack of value of serum albumin as a predictor of nutritional status ( Figure 3, A and B) correspond to and extend previous results reported by us (28) and others (29) showing that serum albumin is a poor predictor of nutritional status in dialysis patients. The current results support views expressed by The results show that the added value of using serum albumin over and above prediction obtained by using only information about age, sex, and comorbid diabetes and CVD is negligible.…”

Longitudinal study of leptin levels in chronic hemodialysis patients

“…Of interest is the observation that adverse changes in body composition parameters occur over time, supporting the hypothesis that end-stage renal disease is associated with wasting as proposed in some [43,44] but not all [45] of the previous studies. The results of our study were consistent with those reported by Johansen et al [43] who did not find significant changes in any of the biochemical markers with time, but a significant reduction in phase angle over 1 year follow up was evident in prevalent HD patients.…”

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

“…Bossola et al (48) found stable levels of CRP over 3 years of observation in a cohort of prevalent hemodialysis patients. In contrast, Kaysen et al (43) showed that the levels of CRP and other acute-phase proteins varied considerably over time in 37 participants of the HEMO study.…”