Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients

George Kaysen, G. M. Chertow, R. Adhikarla, B. Young, C. Ronco, N. W. Levin

Research output: Contribution to journalArticlepeer-review

160 Scopus citations

Abstract

Background. Cross-sectional studies have shown an inverse correlation between serum C-reactive protein (CRP) and serum albumin concentration in hemodialysis patients. The net effects of inflammation and dietary protein intake on nutritional markers over time are unknown. Methods. To explore the effects of CRP and normalized protein catabolic rate (nPCR) on serum albumin and creatinine, we analyzed six consecutive months of laboratory data from 364 hemodialysis patients, using a multivariable Mixed model with conservative biases. Results. The overall trend over time in serum albumin was slightly positive (0.039 g/dL/month) and in serum creatinine slightly negative (-0.052 mg/dL/month). With increasing CRP, serum albumin declined significantly (-0.124 g/dL/month per unit increase in log CRP, adjusted for age, gender, race, diabetes, and nPCR, P < 0.0001). Serum albumin increased with increasing nPCR (0.021 g/dL/month per 0.1 g/kg/day, P < 0.0001). The effect of CRP on albumin was attenuated in African Americans and at a higher nPCR. Corresponding values for creatinine mirrored those for albumin. With increasing CRP, creatinine declined significantly [-0.142 mg/dL/month per unit increase in log CRP, adjusted for age, gender, race, diabetes (time since initiation of dialysis; vintage), Kt/V, and nPCR, P = 0.0021. Serum creatinine increased with increasing nPCR (0.183 mg/dL/month per g/kg/day, P < 0.0001). Conclusions. Proxies of inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. These data provide a rationale for prospective testing of dietary protein supplementation in hemodialysis patients with biochemical evidence of ongoing inflammation and "malnutrition".

Original languageEnglish (US)
Pages (from-to)333-340
Number of pages8
JournalKidney International
Volume60
Issue number1
DOIs
StatePublished - 2001

Keywords

  • Acute phase response
  • C-reactive protein
  • Hypoalbuminemia
  • Malnutrition
  • Normalized protein catabolic rate
  • Nutritional markers
  • Protein energy malnutrition

ASJC Scopus subject areas

  • Nephrology

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