Significance of Albumin and C-Reactive Protein Variations in 300 End Stage Renal Disease Patients in Tehran University of Medical Sciences Hospitals During Year 2010
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Abstract
Protein- energy malnutrition, wasting and inflammation are frequent complication among patients with end-stage renal disease (ESRD). Malnutrition is associated with cardiac co-morbidity, inflammation and poor survival in ESRD patients. Serum albumin is a well-known marker of nutrition in ESRD patients. Serum albumin is still the most commonly used nutritional marker in ESRD patients. C-reactive protein (CRP), the major acute phase response (APR) protein is elevated in these patients. High CRP levels are linked to the degree of atherosclerosis in coronary, peripheral, and extracranial brain arteries. The aim of the present study was to investigate nutritional factor (albumin) and CRP levels in ESRD patients. In this cross- sectional study a total of 300 patients who had ESRD and had been on hemodialysis treatment for at least 6 months were selected. The laboratory tests consisted of measurement of CRP and albumin using high sensitive ELISA kits. The study patients included 157 males (52.3%) and 143 females (47.7%) with average age of 41.5±14.3 years. Mean CRP level was 7.96 mg/ dl (±1.52), mean serum albumin was 4.07 g/dl (±0.19).Of 300 patients, 21 died (7%). These were patients with serum albumin <4 g/dl and CRP>9.5 mg/dl. This study showed that low albumin and high CRP levels are the main predictors for death. There was a significant difference between CRP and albumin levels in ESRD patients (P<0.0001). Measuring CRP as a marker of inflammation can be helpful in managing these patients.
Shaheen FAM, AL-Khader AA. Epidemiology and causes of End stage Renal Disease (ESRD). Saudi J Kidney Dis Transplant 2005;16(3):277-81.
Kopple JD, Greene T, Chumlea WC, Hollinger D, Maroni BJ, Merrill D, Scherch LK, Schulman G, Wang SR, Zimmer GS. Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. Kidney Int 2000;57(4):1688-703.
Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, Bergström J. Factors predicting malnutrition in hemodialysis patients: a crosssectional study. Kidney Int 1998;53(3):773-82.
Stenvinkel P, Heimbürger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55(5):1899-911.
Stenvinkel P, Barany P, Chung SH, Lindholm B, Heimbürger O. A comparative analysis of nutritional parameters as predictors of outcome in male and female ESRD patients. Nephrol Dial Transplant 2002;17(7):1266-74.
Avram MM, Goldwasser P, Erroa M, Fein PA. Predictors of survival in continuous ambulatory peritoneal dialysis patients: the importance of prealbumin and other nutritional and metabolic markers. Am J Kidney Dis 1994;23(1):91-8.
Jansen MA, Korevaar JC, Dekker FW, Jager KJ, Boeschoten EW, Krediet RT; NECOSAD Study Group. Renal function and nutritional status at the start of chronic dialysis treatment. J Am Soc Nephrol 2001;12(1):157-63.
Caimi G, Carollo C, Lo Presti R. Pathophysiological and clinical aspects of malnutrition in chronic renal failure. Nutr Res Rev 2005;18(1):89-97.
Kaysen GA. Biological basis of hypoalbuminemia in ESRD. J Am Soc Nephrol 1998;9(12):2368-76.
Heimburger O, Bergstrom J, Lindholm B. Is serum albumin an indicator of nutritional status in CAPD patients? Perit Dial Intl 1994;14:108-14.
Jones CH, Newstead CG, Will EJ, Smye SW, Davison AM. Assessment of nutritional status in CAPD patients: serum albumin is not a useful measure. Nephrol Dial Transplant 1997;12(7):1406-13.
Heimbürger O, Qureshi AR, Blaner WS, Berglund L, Stenvinkel P. Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis 2000;36(6):1213-25.
Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial 2002;15(5):329-37.
Mitch WE. Malnutrition: a frequent misdiagnosis for hemodialysis patients. J Clin Invest 2002;110(4):437-9.
Arici M, Walls J. End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int 2001;59(2):407-14.
Razeghi E, Omati H, Maziar S, Khashayar P, Mahdavi- Mazdeh M. Chronic inflammation increases risk in hemodialysis patients. Saudi J Kidney Dis Transpl 2008;19(5):785-9.
Grootendorst DC, de Jager DJ, Brandenburg VM, Boeschoten EW, Krediet RT, Dekker FW; NECOSAD Study Group. Excellent agreement between C-reactive protein measurement methods in end-stage renal disease patients--no additional power for mortality prediction with high-sensitivity CRP. Nephrol Dial Transplant 2007;22(11):3277-84.
Harris TB, Ferrucci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH Jr, Heimovitz H, Cohen HJ, Wallace R. Associations of elevated interleukin-6 and C-reactiveprotein levels with mortality in the elderly. Am J Med 1999;106(5):506-12.
Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ, Kusek JW, Collins AJ, Levey AS, Sarnak MJ. Creactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 2005;68(2):766-72.
Bensen JT, Langefeld CD, Li L, McCall CE, Cousart SL, Dryman BN, Freedman BI, Bowden DW. Association of an IL-1A 3'UTR polymorphism with end-stage renal disease and IL-1 alpha expression. Kidney Int 2003;63(4):1211-9.
Kaysen GA. Interpretation of plasma protein measurements in end-stage renal disease. Blood Purif 2000;18(4):337-42.
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(5):458-82.
Steinman TI. Serum albumin: its significance in patients with ESRD. Semin Dial 2000;13(6):404-8.
Wang AY, Sea MM, Ho ZS, Lui SF, Li PK, Woo J. Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr 2005;81(1):79-86.
Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999;55(2):648-58.
Helal I, Smaoui W, Hamida FB, Ouniss M, Aderrahim E, Hedri H, Elyounsi F, Maiz HB, Abdallah TB, Kheder A. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients. Saudi J Kidney Dis Transpl 2010;21(1):59-62.
Kato A, Takita T, Furuhashi M, Maruyama Y, Hishida A. Comparison of serum albumin, C-reactive protein and carotid atherosclerosis as predictors of 10-year mortality in hemodialysis patients. Hemodial Int 2010;14(2):226-32.
Fellah H, Hammami MB, Feki M, Boubaker K, Abdallah TB, Lacour B, Mebazaa A, Kaabachi N. Predictors for cardiovascular morbidity and overall mortality in Tunisian ESRD patients: a six year prospective study. Clin Biochem 2009;42(7-8):648-53.
Pecoits-Filho R, Bárány P, Lindholm B, Heimbürger O, Stenvinkel P. Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant 2002;17(9):1684-8.
Honda H, Qureshi AR, Heimbürger O, Barany P, Wang K, Pecoits-Filho R, Stenvinkel P, Lindholm B. Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis 2006;47(1):139-48.
Mak RH, Cheung WW. Is ghrelin a biomarker for mortality in end-stage renal disease? Kidney Int 2011;79(7):697-9.
Dashti N, Einollahi N, Nabatchian F. Leptin and Interleukin-6 in End-Stage Renal Disease. Pak J Med Sci 2008;24(5):694-97.
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| Issue | Vol 50, No 3 (2012) | |
| Section | Articles | |
| Keywords | ||
| Hypoalbuminemia CRP ESRD CVD | ||
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