Biological basis of hypoalbuminemia in ESRD.
Biological basis of hypoalbuminemia in ESRD.
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发表时间：
1998-12
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通讯作者：
G. Kaysen
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作者：
G. Kaysen
低白蛋白血症与接受腹膜透析（PD）或血液透析（HD）的终末期肾病（ESRD）患者的死亡率相关。血清白蛋白浓度由其合成速率、分解代谢速率常数（单位时间内分解代谢的血管池分数）、外部损失和从血管到血管外空间的再分布决定。透析患者的低白蛋白血症主要是HD和PD患者白蛋白合成速率降低的结果，在PD患者中，也是经腹膜白蛋白丢失的结果。持续性非卧床腹膜透析患者能够增加白蛋白的合成以替代损失。因此，ESRD不直接抑制白蛋白合成。在HD和PD患者中，白蛋白合成速率与一种潜在急性期蛋白（α 2巨球蛋白）的血清浓度成反比，白蛋白浓度与C反应蛋白或血清淀粉样蛋白A的浓度成反比。白蛋白合成减少的原因主要是对炎症的反应（急性期反应），尽管营养不足也可能起作用。炎症反应的原因并不明显。没有证据表明白蛋白转移到血管外空间或通过体积扩张稀释血浆在导致ESRD患者低白蛋白血症中起任何作用。
Hypoalbuminemia is associated with mortality in patients with end-stage renal disease (ESRD) maintained either on peritoneal dialysis (PD) or hemodialysis (HD). Serum albumin concentration is determined by its rate of synthesis, by the catabolic rate constant (the fraction of the vascular pool catabolized per unit time), by external losses, and by redistribution from the vascular to the extravascular space. Hypoalbuminemia in dialysis patients is primarily a consequence of reduced albumin synthesis rate in both HD and PD patients, and in the case of PD patents, of transperitoneal albumin losses as well. Continuous ambulatory peritoneal dialysis patients are able to increase albumin synthesis to replace losses. Thus, ESRD does not directly suppress albumin synthesis. The rate of albumin synthesis is inversely proportional to the serum concentration of one potential acute phase protein (alpha2 macroglobulin), and albumin concentration is inversely proportional to that of either C-reactive protein or serum amyloid A in both HD and PD patients. The cause of decreased albumin synthesis is primarily a response to inflammation (the acute phase response), although it is possible that inadequate nutrition may also contribute. The cause of the inflammatory response is not immediately evident. There is no evidence that shifts of albumin to the extravascular space or that dilution of the plasma by volume expansion plays any role in causing hypoalbuminemia in ESRD patients.