Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure

Berthil H C M T Prinsen, Ton J. Rabelink, Jaap J. Beutler, George A. Kaysen, Jose De Boer, Walther H. Boer, E. Christiaan Hagen, Ruud Berger, Monique G M De Sain-Van Der Velden

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background. Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown. Methods. In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N = 6), patients on peritoneal dialysis (N = 7) and control subjects (N = 8) using L-[1-13C]-valine. Results. Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P < 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P < 0.01) as well as patients on peritoneal dialysis (P < 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 ± 9 mg/kg/day versus 93 ± 9 mg/kg/day, P < 0.05; ASR fibrinogen, 45 ± 4 mg/kg/day versus 29 ± 3 mg/kg/day, P < 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r2 = 0.665, P < 0.0001, N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance. Conclusion. Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.

Original languageEnglish (US)
Pages (from-to)1495-1504
Number of pages10
JournalKidney International
Volume64
Issue number4
DOIs
StatePublished - Oct 1 2003

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Fibrinogen
Chronic Kidney Failure
Albumins
Peritoneal Dialysis
Hypoalbuminemia
Serum Albumin
Ascitic Fluid
Dialysis Solutions
Valine
Acidosis
Malnutrition
Insulin Resistance
Dialysis
Atherosclerosis
Cardiovascular Diseases
Urine
Inflammation

Keywords

  • Albumin
  • Amino acids
  • Fibrinogen
  • Hyperfibrinogenemia
  • Hypoalbuminemia
  • Peritoneal dialysis
  • Renal failure

ASJC Scopus subject areas

  • Nephrology

Cite this

Prinsen, B. H. C. M. T., Rabelink, T. J., Beutler, J. J., Kaysen, G. A., De Boer, J., Boer, W. H., ... De Sain-Van Der Velden, M. G. M. (2003). Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure. Kidney International, 64(4), 1495-1504. https://doi.org/10.1046/j.1523-1755.2003.00211.x

Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure. / Prinsen, Berthil H C M T; Rabelink, Ton J.; Beutler, Jaap J.; Kaysen, George A.; De Boer, Jose; Boer, Walther H.; Hagen, E. Christiaan; Berger, Ruud; De Sain-Van Der Velden, Monique G M.

In: Kidney International, Vol. 64, No. 4, 01.10.2003, p. 1495-1504.

Research output: Contribution to journalArticle

Prinsen, BHCMT, Rabelink, TJ, Beutler, JJ, Kaysen, GA, De Boer, J, Boer, WH, Hagen, EC, Berger, R & De Sain-Van Der Velden, MGM 2003, 'Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure', Kidney International, vol. 64, no. 4, pp. 1495-1504. https://doi.org/10.1046/j.1523-1755.2003.00211.x
Prinsen, Berthil H C M T ; Rabelink, Ton J. ; Beutler, Jaap J. ; Kaysen, George A. ; De Boer, Jose ; Boer, Walther H. ; Hagen, E. Christiaan ; Berger, Ruud ; De Sain-Van Der Velden, Monique G M. / Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure. In: Kidney International. 2003 ; Vol. 64, No. 4. pp. 1495-1504.
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abstract = "Background. Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown. Methods. In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N = 6), patients on peritoneal dialysis (N = 7) and control subjects (N = 8) using L-[1-13C]-valine. Results. Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P < 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P < 0.01) as well as patients on peritoneal dialysis (P < 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 ± 9 mg/kg/day versus 93 ± 9 mg/kg/day, P < 0.05; ASR fibrinogen, 45 ± 4 mg/kg/day versus 29 ± 3 mg/kg/day, P < 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r2 = 0.665, P < 0.0001, N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance. Conclusion. Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.",
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AU - Prinsen, Berthil H C M T

AU - Rabelink, Ton J.

AU - Beutler, Jaap J.

AU - Kaysen, George A.

AU - De Boer, Jose

AU - Boer, Walther H.

AU - Hagen, E. Christiaan

AU - Berger, Ruud

AU - De Sain-Van Der Velden, Monique G M

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N2 - Background. Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown. Methods. In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N = 6), patients on peritoneal dialysis (N = 7) and control subjects (N = 8) using L-[1-13C]-valine. Results. Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P < 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P < 0.01) as well as patients on peritoneal dialysis (P < 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 ± 9 mg/kg/day versus 93 ± 9 mg/kg/day, P < 0.05; ASR fibrinogen, 45 ± 4 mg/kg/day versus 29 ± 3 mg/kg/day, P < 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r2 = 0.665, P < 0.0001, N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance. Conclusion. Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.

AB - Background. Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown. Methods. In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N = 6), patients on peritoneal dialysis (N = 7) and control subjects (N = 8) using L-[1-13C]-valine. Results. Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P < 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P < 0.01) as well as patients on peritoneal dialysis (P < 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 ± 9 mg/kg/day versus 93 ± 9 mg/kg/day, P < 0.05; ASR fibrinogen, 45 ± 4 mg/kg/day versus 29 ± 3 mg/kg/day, P < 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r2 = 0.665, P < 0.0001, N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance. Conclusion. Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.

KW - Albumin

KW - Amino acids

KW - Fibrinogen

KW - Hyperfibrinogenemia

KW - Hypoalbuminemia

KW - Peritoneal dialysis

KW - Renal failure

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