Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients

George Kaysen, Joel A. Dubin, Hans Georg Müiller, William E. Mitch, Laura M. Rosales, Nathan W. Levin

Research output: Contribution to journalArticlepeer-review

201 Scopus citations


Background. Serum albumin concentration is a balance among its synthesis rate, fractional catabolic rate (FCR), distribution, dilution in the plasma pool and external loss. The physiologic bases for establishing the level of serum albumin in hemodialysis patients have not been defined despite the association of hypoalbuminemia with excess mortality. Albumin concentration is associated with the levels of several acute phase proteins (APPs), C-reactive protein (CRP), α1 acid glycoprotein (α1 AG), or ceruloplasmin, and with nutritional markers, such as normalized protein catabolic rate (nPCR). Methods. To establish the relationship among parameters that regulate albumin levels and markers of nutrition and inflammation, we injected [125I]-albumin, into 64 hemodialysis patients enrolled in the HEMO study to measure albumin distribution, synthesis and FCR. These variables were related to the levels of acute phase proteins (APPs), nPCR, body mass index (BMI), external albumin loss as well as demographic variables. Albumin distribution, synthesis and FCR were calculated from kinetic modeling, as was the initial plasma volume (PV). Serum albumin, transferrin, CRP, ceruloplasmin and α1 AG were measured weekly. Dialysate was collected during one dialysis each week to measure albumin loss. Results were analyzed by multiple linear regression. Results. Albumin concentration correlated with its synthesis rate and FCR, but not with PV or its distribution between the vascular and extravascular pools. Albumin concentration also correlated with nPCR and α1 AG. However, albumin synthesis was directly related most strongly to PV and BMI (or nPCR), but not to levels of APPs. By contrast, albumin FCR correlated positively with both α1 AG and ceruloplasmin. Conclusion. Albumin concentration in dialysis patients changes with inflammation and nutritional status through their effects on albumin catabolism and synthesis, respectively. Within the range of albumin levels in these patients, nutritional variables primarily affected albumin synthesis while inflammation caused hypoalbuminemia by increasing albumin FCR. Albumin synthesis also increased in proportion to PV. The result of this is that PV expansion does not contribute to hypoalbuminemia.

Original languageEnglish (US)
Pages (from-to)2240-2249
Number of pages10
JournalKidney International
Issue number6
StatePublished - 2002


  • α1 acid glycoprotein
  • Acute phase
  • Albumin synthesis
  • Body mass index
  • C-reactive protein
  • Ceruloplasmin
  • Fractional catabolic rate
  • nPCR
  • Nutrition
  • Plasma volume

ASJC Scopus subject areas

  • Nephrology


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