The effect of albumin leakage in hemodialysis patients on redox status of serum albumin

Nagai, Kojiro; Tsuchida, Kenji; Hirose, Daisuke; Michiwaki, Hiroyuki; Hann, Michael; Kanayama, Hiro‐omi; Doi, Toshio; Murata, Jun

doi:10.1007/s10047-016-0900-2

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…When we try to remove larger LMWPs, we have to accept ∼3–5 g of albumin leakage and, occasionally, this may be >10 g in some circumstances [ 67 ]. Nagai et al [ 68 ] reported that dialysis modalities with ≥3 g of albumin loss during a dialysis session had better survival rates than those with <3 g. They also reported that protein-leaking dialysis was favorable to maintain the serum level of the reduced form of albumin, which was recognized as having protective effects on dialysis patients from cardiovascular events [ 69 ]. However, large amounts of albumin leakage should be avoided because this leads to hypoalbuminemia and lipoprotein metabolism abnormalities.…”

Section: Present Status Of Protein-permeable Dialysis In Japanmentioning

confidence: 99%

Current approaches to middle molecule removal: room for innovation

Masakane¹,

Sakurai

2018

Nephrology Dialysis Transplantation

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Aggressive removal of middle molecules or larger low-molecular-weight proteins (LMWPs) has been a growing concern following studies on their harmful effects on the mortality and morbidity of chronic dialysis patients. To remove larger LMWPs and some protein-bound uremic toxins (PBUTs), high- and medium-cutoff (HCOs and MCOs, respectively) membranes, convective therapy and protein adsorptive membranes are available. When we use HCO or MCO membranes for convective therapy, we have to take care to avoid massive albumin leakage during a dialysis session. Convection volume is an important element to increase middle molecule removal; however, a larger convection volume has a risk of larger leakage of albumin. Predilution hemodiafiltration is a useful measurement to increase larger LMWPs without massive albumin leakage. β2-microglobulin (B2M), α1-microglobulin (A1M) and albumin leakage during a dialysis session are useful parameters for assessing middle-molecule removal. Reduction ratios of B2M >80% and of A1M >35% are favorable to improve severe dialysis-related symptoms. The efficacy of middle molecule removal should be evaluated in comparison with clinical outcomes, mortality, morbidity and the improvement of dialysis-related symptoms. Recently some dialysis-related symptoms such as sleep disturbance, skin itchiness and dialysis hypotension have been recognized as good surrogate makers for mortality. Further studies to evaluate the relationship between middle molecule or PBUTs removal and the improvement of patient symptoms should be performed in well-designed randomized controlled trials.

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Section: Present Status Of Protein-permeable Dialysis In Japanmentioning

confidence: 99%

Current approaches to middle molecule removal: room for innovation

Masakane¹,

Sakurai

2018

Nephrology Dialysis Transplantation

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“…The maximum admissible amount of albumin leakage remains unclear. However, we have already clarified that HD with 9.1 g albumin leakage per HD session for 1 month may induce a significant decrease of serum albumin and increase of serum total cholesterol, even though the level of the reduced form of albumin remained stable, which is associated with cardiovascular disease in dialysis patients . Dyslipidemia can be harmful in patients undergoing albumin leaky HD.…”

Section: Discussionmentioning

confidence: 99%

Implications of Albumin Leakage for Survival in Maintenance Hemodialysis Patients: A 7‐year Observational Study

Nagai

Tsuchida²,

Ishihara³

et al. 2017

Ther Apher Dial

Self Cite

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Albumin leakage during hemodialysis (HD) presents a clinical dilemma. However, protein-binding uremic toxins are suggested to be responsible for increased mortality. No one has investigated the relationship between albumin leakage and mortality. Therefore, the purpose of this observational study was to analyze the association of albumin leakage with mortality in 690 HD patients who survived one year after enrollment. They were divided to three groups who received HD with large (3 g or more per HD session), middle (1 to 3 g) or small (less than 1 g) amount of albumin leakage, respectively. A propensity score analysis minimizing indication bias was performed. Consequently, in a 7-year observation period, 212 patients died. Albumin leakage 3 g or more per HD session provided better prognosis than albumin leakage less than 3 g per HD session. In conclusion, clinically acceptable large albumin leakage provides beneficial effects on mortality in maintenance HD patients.

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“…The algorithm proposed is based on some arbitrary, or unproven assumptions: Albumin is the most relevant prognostic marker in both HDF and HD [ 70 , 71 , 72 , 73 ]; Albumin loss is non-selective, and low serum albumin levels have to be avoided [ 74 , 75 , 76 , 77 , 78 ] (i.e., “toxic albumin”, is not selectively lost; toxic albumin is albumin-linked to uremic toxins, for which loss should be promoted according to some authors [ 73 , 74 ]; Different dialyzers in the same category are equivalent (high-, medium- or low-flux) in terms of performance and albumin leakage (while this is not entirely true, a detailed discussion is beyond the scope of this review); Loss of albumin is higher in the first minutes of HDF, supporting the choice of low-permeability membranes in the case of more frequent dialysis [ 74 ]; Loss of albumin is also a marker of loss of other potentially useful nutrients, including vitamins; such a loss may contribute to malnutrition; Adsorption by dialysis membranes is not a relevant element in the removal of uremic toxins; if present, it is similar in similar categories of dialyzers [ 78 ]. …”

Section: Arbitrary (Or Unproven) Assumptionsmentioning

confidence: 99%

“…Albumin loss is non-selective, and low serum albumin levels have to be avoided [ 74 , 75 , 76 , 77 , 78 ] (i.e., “toxic albumin”, is not selectively lost; toxic albumin is albumin-linked to uremic toxins, for which loss should be promoted according to some authors [ 73 , 74 ];…”

Section: Arbitrary (Or Unproven) Assumptionsmentioning

confidence: 99%

Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status

Piccoli

Nielsen

Gendrot

et al. 2018

JCM

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There is no simple way to prescribe hemodialysis. Changes in the dialysis population, improvements in dialysis techniques, and different attitudes towards the initiation of dialysis have influenced treatment goals and, consequently, dialysis prescription. However, in clinical practice prescription of dialysis still often follows a “one size fits all” rule, and there is no agreed distinction between treatment goals for the younger, lower-risk population, and for older, high comorbidity patients. In the younger dialysis population, efficiency is our main goal, as assessed by the demonstrated close relationship between depuration (tested by kinetic adequacy) and survival. In the ageing dialysis population, tolerance is probably a better objective: “good dialysis” should allow the patient to attain a stable metabolic balance with minimal dialysis-related morbidity. We would like therefore to open the discussion on a personalized approach to dialysis prescription, focused on efficiency in younger patients and on tolerance in older ones, based on life expectancy, comorbidity, residual kidney function, and nutritional status, with particular attention placed on elderly, high-comorbidity populations, such as the ones presently treated in most European centers. Prescription of dialysis includes reaching decisions on the following elements: dialysis modality (hemodialysis (HD) or hemodiafiltration (HDF)); type of membrane (permeability, surface); and the frequency and duration of sessions. Blood and dialysate flow, anticoagulation, and reinfusion (in HDF) are also briefly discussed. The approach described in this concept paper was developed considering the following items: nutritional markers and integrated scores (albumin, pre-albumin, cholesterol; body size, Body Mass Index (BMI), Malnutrition Inflammation Score (MIS), and Subjective Global Assessment (SGA)); life expectancy (age, comorbidity (Charlson Index), and dialysis vintage); kinetic goals (Kt/V, normalized protein catabolic rate (n-PCR), calcium phosphate, parathyroid hormone (PTH), beta-2 microglobulin); technical aspects including vascular access (fistula versus catheter, degree of functionality); residual kidney function and weight gain; and dialysis tolerance (intradialytic hypotension, post-dialysis fatigue, and subjective evaluation of the effect of dialysis on quality of life). In the era of personalized medicine, we hope the approach described in this concept paper, which requires validation but has the merit of providing innovation, may be a first step towards raising attention on this issue and will be of help in guiding dialysis choices that exploit the extraordinary potential of the present dialysis “menu”.

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The effect of albumin leakage in hemodialysis patients on redox status of serum albumin

Cited by 13 publications

References 11 publications

Current approaches to middle molecule removal: room for innovation

Current approaches to middle molecule removal: room for innovation

Implications of Albumin Leakage for Survival in Maintenance Hemodialysis Patients: A 7‐year Observational Study

Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status

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