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J Am Soc Nephrol. 2010 Feb;21(2):223-30. doi: 10.1681/ASN.2009020213. Epub 2010 Jan 14.
The decision by nephrologists, renal dietitians, federal agencies, health care payers, large dialysis organizations, and the research community to embrace serum albumin as an important index of nutrition and clinical performance is based on numerous misconceptions. Patients with analbuminemia are not malnourished and individuals with simple malnutrition are rarely hypoalbuminemic. With the possible exception of kwashiorkor, a rare nutritional state, serum albumin is an unreliable marker of nutritional status. Furthermore, nutritional supplementation has not been clearly shown to raise levels of serum albumin. The use of serum albumin as a quality care index is also problematic. It has encouraged a reflexive reliance on expensive and unproven interventions such as dietary supplements and may lead to adverse selection of healthier patients by health care providers. The authors offer a rationale for considering albumin as a marker of illness rather than nutrition. Viewed in this manner, hypoalbuminemia may offer an opportunity to improve patient well-being by identifying and treating the underlying disorder.
肾病学家、肾脏营养师、联邦机构、医疗保健支付方、大型透析组织和研究界决定将血清白蛋白作为营养和临床性能的重要指标，这是基于许多误解。低白蛋白血症患者并非营养不良，单纯营养不良的个体很少出现低白蛋白血症。除了罕见的营养不良状态——夸希奥科病外，血清白蛋白是营养状况的不可靠标志物。此外，营养补充并没有明确表明能提高血清白蛋白水平。将血清白蛋白用作质量护理指标也存在问题。它促使人们不假思索地依赖昂贵且未经证实的干预措施，如膳食补充剂，并且可能导致医疗保健提供者对更健康的患者进行不利选择。作者提出了将白蛋白视为疾病标志物而不是营养标志物的理由。从这种观点来看，通过识别和治疗潜在疾病，低白蛋白血症可能为改善患者的健康状况提供机会。
