Harold Simmons Center for Kidney Disease Research and Epidemiology, Torrance, CA, USA.
Int Urol Nephrol. 2013 Feb;45(1):215-27. doi: 10.1007/s11255-012-0170-8. Epub 2012 Apr 15.
Serum albumin is one of the strongest mortality predictors in maintenance hemodialysis (MHD) patients. Yet, the degree to which serum albumin represents dietary protein intake or an inflammatory state, among others, is not clear. We hypothesize that these inadequate protein intake and inflammation contribute somewhat equally to hypoalbuminemia.
In a cross-sectional analysis, we examined correlates of low serum albumin, <3.8 g/dL, in 812 MHD patients in whom interleukin-6 (IL-6) and normalized protein nitrogen appearance (nPNA), also known as normalized protein catabolic rate (nPCR), were also measured. Logistic regression estimated odds ratios were employed, and spline models were plotted to examine the likelihood of relatively low serum albumin <3.8 g/dL.
Mean age (±SD) of patients was 54 ± 15 years; 53 % of patients were men, 50 % Hispanic, 31 % African-American, and 55 % diabetic. The mean dialysis vintage was 31 ± 34 months (median: 19, inter-quartile range: 7-44 months). The baseline serum albumin, averaged over a 3-month period (mean ± SD), was 3.88 ± 0.38 g/mL. The unadjusted correlation coefficients of l IL-6 and nPNA with serum albumin were -0.36 and +0.20, respectively (p < 0.001 for each comparison). The likelihood for an albumin <3.8 gr/dL increased linearly with decreasing nPNA and rising serum IL-6. This trend was steeper with increasing serum IL-6 up to a concentration of 30 ng/mL.
Both low protein intakes and a high state of inflammation are associated with low serum albumin in MHD patients.
血清白蛋白是维持性血液透析（MHD）患者最强的死亡预测因子之一。然而，血清白蛋白代表饮食蛋白摄入还是炎症状态等程度尚不清楚。我们假设这些蛋白质摄入不足和炎症状态对低白蛋白血症的贡献程度大致相同。
在一项横断面分析中，我们检查了 812 名 MHD 患者中低血清白蛋白（<3.8 g/dL）的相关因素，这些患者还测量了白细胞介素-6（IL-6）和标准化蛋白氮表观（nPNA），也称为标准化蛋白分解率（nPCR）。使用逻辑回归估计比值比，并绘制样条模型来检查相对低血清白蛋白<3.8 g/dL 的可能性。
患者的平均年龄（±标准差）为 54 ± 15 岁；53%的患者为男性，50%为西班牙裔，31%为非裔美国人，55%为糖尿病患者。平均透析龄为 31 ± 34 个月（中位数：19，四分位距：7-44 个月）。3 个月期间的平均血清白蛋白（平均值±标准差）为 3.88 ± 0.38 g/mL。未调整的 IL-6 和 nPNA 与血清白蛋白的相关系数分别为-0.36 和+0.20（每种比较的 p < 0.001）。白蛋白<3.8 gr/dL 的可能性随 nPNA 的降低和血清 IL-6 的升高呈线性增加。随着血清 IL-6 浓度的增加，这种趋势变得更加陡峭，最高可达 30 ng/mL。
低蛋白摄入和高炎症状态都与 MHD 患者的低血清白蛋白有关。
