Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Clin J Am Soc Nephrol. 2012 Sep;7(9):1446-53. doi: 10.2215/CJN.10251011. Epub 2012 Jun 21.
Serum albumin is a widely used biomarker of nutritional status in patients with CKD; however, its usefulness is debated. This study investigated serum albumin and its correlation with several markers of nutritional status in incident and prevalent dialysis patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a cross sectional study, serum albumin (bromocresol purple), and other biochemical (serum creatinine), clinical (subjective global assessment [SGA]), anthropometric (handgrip strength, skinfold thicknesses), and densitometric (dual energy x-ray absorptiometry) markers of nutritional status were assessed in 458 incident (61% male; mean age 54 +/- 13 years; GFR, 6.6 +/-2.3 ml/min per 1.73 m(2); recruited 1994–2010) and 383 prevalent (56% male; mean age 62 +/- 14 years; recruited 1989–2004) dialysis patients.
In incident patients: serum albumin was correlated with sex (beta = -0.13; P = 0.02), diabetes mellitus (beta = -0.18; P = 0.004), and urinary albumin excretion (beta = -0.42; P = 0.001) but less so with poor nutritional status (SGA score >1; beta = -0.19; P = 0.001). In prevalent patients, serum albumin was correlated with age (beta = -0.14; P = 0.05), high-sensitivity C-reactive protein (beta = -0.34; P = 0.001), diabetes mellitus (beta = -0.11; P = 0.04), and SGA score >1 (beta = -0.14; P = 0.003). In predicting nutritional status assessed by SGA and other markers, adding serum albumin to models that included age, sex, diabetes, and cardiovascular disease did not significantly increase explanatory power.
In incident and prevalent dialysis patients,serum albumin correlates poorly with several markers of nutritional status. Thus, its value as a reliable marker of nutritional status in patients with ESRD is limited. In addition, the following inconsistencies between the main text and Tables 1 and 3 are also corrected as follows. (1) In Table 1, the GFR initially written as 6 +/- 3 ml/min per 1.73(2) should be corrected to 6.6 +/- 2.3 ml/min per 1.73(2). (2) On line 11 of page 1448, under the Clinical Correlates of Serum Albumin Concentration section describing the multiple regression models (Table 3), the P value was initially written as“serum albumin was associated with age (beta = -0.14; P = 0.05).” The P value should be corrected to have the same value as that given in Table 3 (beta = -0.14; P = 0.005. [corrected].
血清白蛋白是慢性肾脏病患者营养状况的常用生物标志物，但它的作用仍存在争议。本研究旨在调查新发病例和现有透析患者的血清白蛋白及其与多种营养状况标志物的相关性。
在一项横断面研究中，评估了 458 例新发病例（61%为男性；平均年龄 54 ± 13 岁；肾小球滤过率 [GFR] 为 6.6 ± 2.3 ml/min/1.73m²；招募时间为 1994-2010 年）和 383 例现有透析患者（56%为男性；平均年龄 62 ± 14 岁；招募时间为 1989-2004 年）的血清白蛋白（溴甲酚紫）和其他生化指标（血清肌酐）、临床指标（主观综合营养评估 [SGA]）、人体测量学指标（握力、皮褶厚度）和密度测定学指标（双能 X 射线吸收法）。
在新发病例中，血清白蛋白与性别（β = -0.13；P = 0.02）、糖尿病（β = -0.18；P = 0.004）和尿白蛋白排泄量（β = -0.42；P = 0.001）呈负相关，但与营养不良状况（SGA 评分＞1；β = -0.19；P = 0.001）的相关性较差。在现有透析患者中，血清白蛋白与年龄（β = -0.14；P = 0.05）、高敏 C 反应蛋白（β = -0.34；P = 0.001）、糖尿病（β = -0.11；P = 0.04）和 SGA 评分＞1（β = -0.14；P = 0.003）呈负相关。在预测 SGA 和其他标志物评估的营养状况方面，将血清白蛋白添加到包括年龄、性别、糖尿病和心血管疾病的模型中，并没有显著增加解释能力。
在新发病例和现有透析患者中，血清白蛋白与多种营养状况标志物的相关性较差。因此，其作为慢性肾脏病患者营养状况可靠标志物的价值有限。此外，以下是对正文和表 1、3 之间的不一致之处进行的更正：（1）表 1 中，最初写成“GFR 为 6 +/- 3 ml/min/1.73（2）”的 GFR 应更正为“GFR 为 6.6 +/- 2.3 ml/min/1.73（2）”。（2）第 1448 页第 11 行，在描述多元回归模型（表 3）的“血清白蛋白浓度的临床相关性”部分，最初写成“血清白蛋白与年龄相关（β=-0.14；P=0.05）”。P 值应更正为与表 3 中给出的值相同（β=-0.14；P=0.005）。[更正]
