Factors influencing serum albumin in dialysis patients.
Factors influencing serum albumin in dialysis patients.
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DOI：
10.1016/s0272-6386(98)70174-x
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发表时间：
1998-12-01
期刊：
影响因子：
--
通讯作者：
Kaysen, G A
中科院分区：
文献类型：
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作者：
Yeun, J Y;Kaysen, G A
低白蛋白血症是透析患者发病率和死亡率的主要危险因素。低白蛋白血症的近因可能是导致这些事件的原因，而不是低白蛋白血症本身。由于蛋白质-热量营养不良减少白蛋白合成，低白蛋白血症被归因于透析不足导致的营养摄入不足。然而，血清白蛋白（Salb）水平是由几个其他因素决定的：血浆容量扩张，白蛋白再分布，外源性损失，部分分解率（FCR）增加，合成减少。白蛋白合成减少是血液透析（HD）患者低白蛋白血症的主要原因。对少数腹膜透析（PD）患者的研究表明，外源性白蛋白丢失和容量扩张是促成机制。然而，营养不良和炎症都抑制白蛋白的合成。随着透析充分性的改善，最近的研究无法显示透析充分性与Salb水平之间的任何关系。此外，Salb水平似乎是透析患者营养状况的不良标志物，与其他营养指标相比，如主观总体评估评分，人体测量和饮食摄入。相反，炎症反应产生的细胞因子和阳性急性期反应物已被确定为透析患者低白蛋白血症的重要因素。这些标志物与低白蛋白血症相关，并在预测死亡率方面取代Salb水平。多变量分析确定炎症和营养状态标志物为HD患者低白蛋白血症的独立预测因子，炎症和腹膜白蛋白丢失标志物为PD患者的独立预测因子。然而，急性期反应和营养不良是密切相关的，因为炎症介质也抑制食欲，增加肌肉紧张，并导致进行性恶病质。未来的研究应该集中在阐明炎症刺激和急性期反应和营养状况之间的复杂相互作用。
Hypoalbuminemia is a major risk factor for morbidity and mortality in dialysis patients. The proximate cause of hypoalbuminemia is probably responsible for these events, and not the hypoalbuminemia itself. Because protein-calorie malnutrition decreases albumin synthesis, hypoalbuminemia has been attributed to poor nutritional intake resulting from underdialysis. However, serum albumin (Salb) level is determined by several other factors: plasma volume expansion, albumin redistribution, exogenous loss, increased fractional catabolic rate (FCR), and decreased synthesis. Decreased albumin synthesis is primarily responsible for hypoalbuminemia in hemodialysis (HD) patients. Studies of a smaller number of peritoneal dialysis (PD) patients suggest exogenous albumin loss and volume expansion as contributing mechanisms. However, both malnutrition and inflammation suppress albumin synthesis. As the adequacy of dialysis has improved, recent studies are unable to show any relation between dialysis adequacy and Salb level. Further, Salb level appears to be a poor marker of nutritional status in dialysis patients when compared with other measures of nutrition, such as subjective global assessment score, anthropometry, and dietary intake. Instead, cytokines and positive acute-phase reactants, produced in response to inflammation, have been identified as important contributors to hypoalbuminemia in dialysis patients. These markers correlate with hypoalbuminemia and supercede Salb level in predicting mortality. Multivariate analysis identifies markers of inflammation and nutritional status as independent predictors of hypoalbuminemia in HD patients and markers of inflammation and peritoneal albumin loss as independent predictors in PD patients. However, the acute-phase response and malnutrition are closely interrelated, because inflammatory mediators also suppress appetite, increase muscle catabolism, and result in progressive cachexia. Future studies should focus on elucidating the inflammatory stimuli and the complex interaction between the acute-phase response and nutritional status.