Reduction of carbamylated albumin by extended hemodialysis.
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ABSTRACT:
SUBMITTER: Perl J
PROVIDER: S-EPMC5380223 | biostudies-literature | 2016 Oct
REPOSITORIES: biostudies-literature
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Reduction of carbamylated albumin by extended hemodialysis.
Perl Jeffrey J Kalim Sahir S Wald Ron R Goldstein Marc B MB Yan Andrew T AT Noori Nazanin N Kiaii Mercedeh M Wenger Julia J Chan Christopher C Thadhani Ravi I RI Karumanchi S Ananth SA Berg Anders H AH
Hemodialysis international. International Symposium on Home Hemodialysis 20160621 4
Introduction Among conventional hemodialysis (CHD) patients, carbamylated serum albumin (C-Alb) correlates with urea and amino acid deficiencies and is associated with mortality. We postulated that reduction of C-Alb by intensive HD may correlate with improvements in protein metabolism and cardiac function. Methods One-year observational study of in-center nocturnal extended hemodialysis (EHD) patients and CHD control subjects. Thirty-three patients receiving 4-hour CHD who converted to 8-hour E ...[more]
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Project description:INTRODUCTION:Hypoalbuminemia is a predictor of poor outcomes in dialysis patients. Among hemodialysis patients, there has not been prior study of whether residual kidney function or decline over time impacts serum albumin levels. We hypothesized that a decline in residual kidney function is associated with an increase in serum albumin levels among incident hemodialysis patients. METHODS:In a large national cohort of 38,504 patients who initiated hemodialysis during 1/2007-12/2011, we examined the association of residual kidney function, ascertained by urine volume and renal urea clearance, with changes in serum albumin over five years across strata of baseline residual kidney function, race, and diabetes using case-mix adjusted linear mixed effects models. FINDINGS:Serum albumin levels increased over time. At baseline, patients with greater urine volume had higher serum albumin levels: 3.44?±?0.48, 3.50?±?0.46, 3.57?±?0.44, 3.59?±?0.45, and 3.65?±?0.46 g/dL for urine volume groups of <300, 300-<600, 600-<900, 900-<1,200, and ?1,200 mL/day, respectively (Ptrend ?<?0.001). Over time, urine volume and renal urea clearance declined and serum albumin levels rose, while the baseline differences in serum albumin persisted across groups of urinary volume. In addition, the rate of decline in residual kidney function was not associated with the rate of change in albumin. DISCUSSION:Hypoalbuminemia in hemodialysis patients is associated with lower residual kidney function. Among incident hemodialysis patients, there is a gradual rise in serum albumin that is independent of the rate of decline in residual kidney function, suggesting that preservation of residual kidney function does not have a deleterious impact on serum albumin levels.
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