Reassessment of Albumin as a Nutritional Marker in Kidney Disease
Reassessment of Albumin as a Nutritional Marker in Kidney Disease
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DOI：
10.1681/asn.2009020213
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发表时间：
2010-02-01
影响因子：
13.6
通讯作者：
Fadem, Stephen Z.
中科院分区：
文献类型：
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作者：
Friedman, Allon N.;Fadem, Stephen Z.
肾病学家、肾脏营养师、联邦机构、医疗保健支付者、大型透析组织和研究团体决定将血清白蛋白作为营养和临床表现的重要指标，这是基于许多误解。无白蛋白血症的患者并不营养不良，单纯营养不良的患者很少出现低白蛋白血症。除了恶性营养不良症（一种罕见的营养状态）之外，血清白蛋白是一种不可靠的营养状态标志物。此外，营养补充还没有明确显示出提高血清白蛋白水平。使用血清白蛋白作为优质护理指标也存在问题。它鼓励了对昂贵和未经证实的干预措施（如膳食补充剂）的反射性依赖，并可能导致卫生保健提供者对健康患者的不利选择。作者提供了将白蛋白视为疾病而不是营养标志物的理由。从这个角度来看，低白蛋白血症可能提供了一个机会，通过识别和治疗潜在的疾病，以改善患者的福祉。
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.