Journal Mobile Options
Table of Contents
Vol. 28, No. 5-6, 2005
Issue release date: March 2006

Hypoalbuminemia in Renal Failure: Pathogenesis and Therapeutic Considerations

Haller C.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Hypoalbuminemia is common in patients with end-stage renal disease (ESRD). It is caused by a combination of a reduced synthesis and an increased degradation of albumin. The altered albumin homeostasis in ESRD patients is caused by a systemic inflammatory state which correlates closely with mortality. Hypoalbuminemia is a strong predictor of an adverse prognosis, but it is not a pathogenic factor in itself. In critically ill patients in intensive care units, the intravenous administration of human serum albumin generally does not improve prognosis. In contrast, in hypoalbuminemic dialysis patients with volume overload and a reduced effective arterial volume the administration of albumin is based on the pathophysiological concept of increasing intravascular oncotic pressure to transfer extravascular fluid into the intravascular compartment for ultrafiltration in order to mobilize edema fluid.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Alderson P, Bunn F, Lefebvre C, Li LLW, Roberts I, Schierhout G: Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2004;18:CD001208.
  2. Bologa RM, Levine DM, Parker TS, Cheigh JS, Serur D, Stenzel KH, Rubin AL: Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients. Am J Kidney Dis 1998;32:107–114.
  3. Capelli JP, Kushner H, Camiscoli TC, Chen SM, Tores MA: Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease care. Am J Kidney Dis 1994;23:808–816.
  4. Combe C, McCullough KP, Asano Y, Ginsberg N, Maroni BJ, Pifer TB: Kidney disease outcomes quality initiative (K/DOQI) and dialysis outcomes and practice patterns study (DOPPS): nutrition guidelines, indicators, and practices. Am J Kidney Dis 2004;44:39–46.
  5. Danielski M, Ikizler TA, McMonagle E, Kane JC, Pupim L, Morrow J, Himmelfarb J: Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy. Am J Kidney Dis 2003;42:286–294.
  6. Don BR, Kaysen G: Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004;17:432–437.
  7. Eckhardt RD, Lewis JH, Murphy TL, Batchelor WH, Davidson CS: Chemical, clinical, and immunological studies on the products of human plasma fractionation. XXXIV. Comparative studies on the nutritive value of orally and intravenously administered human serum albumin in man. J Clin Invest 1947:119–134.
  8. Fujihara CK, Limongi DM, DeOliveira HC, Zatz R: Absence of focal glomerulosclerosis in aging analbuminemic rats. Am J Physiol 1992;262:R947–R954.
  9. Fujihara CK, Limongi DM, Falzone R, Graudenz MS, Zatz R: Pathogenesis of glomerular sclerosis in subtotally nephrectomized analbuminemic rats. Am J Physiol 1991;261:F256–F264.
  10. Herrmann FR, Safran C, Levkoff SE, Minaker KL: Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 1992;152:125–130.
  11. Honkanen E, Gronhagen-Riska C, Teppo AM, Maury CP, Meri S: Acute-phase proteins during hemodialysis: correlation with serum interleukin-1 beta levels and different dialysis membranes. Nephron 1991;57:283–287.
  12. The SAFE Study Investigators: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247–2256.
  13. Kaizu Y, Kimura M, Yoneyama T, Miyaji K, Hibi I, Kumagai H: Interleukin-6 may mediate malnutrition in chronic hemodialysis patients. Am J Kidney Dis 1998;31:93–100.
  14. Kaplan AA, Halley SE, Lapkin RA, Graeber CW: Dialysate protein losses with bleach processed polysulphone dialyzers. Kidney Int 1995;47:573–578.
  15. Kaysen GA: Biological basis of hypoalbuminemia in ESRD. J Am Soc Nephrol 1998;9:2368–2376.
  16. Kaysen GA, Rathore V, Shearer GC, Depner TA: Mechanisms of hypoalbuminemia in hemodialysis patients. Kidney Int 1995;48:510–516.
  17. Kaysen GA, Schoenfeld PY: Albumin homeostasis in patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 1984;25:107–114.
  18. Kirsch R, Frith L, Black E, Hoffenberg R: Regulation of albumin synthesis and catabolism by alteration of dietary protein. Nature 1968;217:578–579.
  19. Lowrie EG, Lew NL: Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458–482.
  20. Memoli B, Libetta C, Rampino T, DeSimone W, Meccariello S, Stangherlin P, Canton AD, Andreucci VE: Interleukin-6 production of uraemic haemodialysed patients: effects of different membranes. Nephrol Dial Transplant 1991;6:96–98.
  21. Minamiyama Y, Takemura S, Inoue M: Albumin is an important vascular tonus regulator as a reservoir of nitric oxide. Biophys Res Commun 1996;225:112–115.
  22. Moshage HJ, Janssen JAM, Franssen JH, Hafkenscheid JCM, Yap SH: Study of the molecular mechanisms of decreased liver synthesis of albumin in inflammation. J Clin Invest 1987;79:1635–1641.
  23. Cochrane Injuries Group Albumin Reviewers: Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ 1998;317:235–240.
  24. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al: Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403–409.
  25. Stafford CT, Lobel SA, Fruge BC, Moffitt JE, Hoff RG, Fadel HE: Anaphylaxis to human serum albumin. Ann Allergy 1988;61:85–88.
  26. Wilkes MM, Navickis RJ: Patient survival after human albumin administration. Ann Intern Med 2001;135:149–164.


Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00