Mukai Hideyuki, Villafuerte Hilda, Qureshi Abdul Rashid, Lindholm Bengt, Stenvinkel Peter
Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Semin Dial. 2018 Sep;31(5):435-439. doi: 10.1111/sdi.12731. Epub 2018 Jun 21.
Low serum albumin (S-Alb) is a frequent feature of end-stage renal disease (ESRD) that independently predicts mortality. Serum albumin has mainly been considered a biomarker of visceral protein and immunocompetence status, fundamental to nutritional assessment. However, low S-albumin level is associated with persistent systemic inflammation and many bodies of evidence show that S-Alb has a limited role as a marker of nutritional status. We reported that a low S-Alb concentration was an independent risk factor for poor outcome in ESRD only in the presence of systemic inflammation. Moreover, the relationships between inflammatory biomarkers and outcome are confounded also by alterations in body composition (such as obese sarcopenia) and oxidative stress. Taken together, S-Alb alone should not be used as a proxy of the nutritional status in a dialysis patient. Its association with dietary intake is poor and low S-Alb values are most often non-nutritional in origin. When analyzing S-Alb to predict mortality risk in ESRD, it should always be combined with measurement of hsCRP.
低血清白蛋白（S-Alb）是终末期肾病（ESRD）的常见特征，可独立预测死亡率。血清白蛋白主要被视为内脏蛋白和免疫能力状态的生物标志物，是营养评估的基础。然而，低S-白蛋白水平与持续性全身炎症相关，许多证据表明S-Alb作为营养状况标志物的作用有限。我们报告称，仅在存在全身炎症的情况下，低S-Alb浓度才是ESRD患者预后不良的独立危险因素。此外，炎症生物标志物与预后之间的关系也因身体组成的改变（如肥胖性肌肉减少症）和氧化应激而混淆。综上所述，单独的S-Alb不应被用作透析患者营养状况的替代指标。它与饮食摄入的关联性较差，低S-Alb值大多并非源于营养因素。在分析S-Alb以预测ESRD患者的死亡风险时，应始终结合高敏C反应蛋白（hsCRP）的测量。
