Serum albumin as predictor of nutritional status in patients with ESRD.
OBJECTIVE
Serum albumin is a widely used biomarker of nutritional status in patients with CKD; however, its usefulness is debated. This study investigated serum albumin and its correlation with several markers of nutritional status in incident and prevalent dialysis patients.


METHODS
In a cross sectional study, serum albumin (bromocresol purple), and other biochemical (serum creatinine), clinical (subjective global assessment [SGA]), anthropometric (handgrip strength, skinfold thicknesses), and densitometric (dual energy x-ray absorptiometry) markers of nutritional status were assessed in 458 incident (61% male; mean age 54 +/- 13 years; GFR, 6.6 +/-2.3 ml/min per 1.73 m(2); recruited 1994–2010) and 383 prevalent (56% male; mean age 62 +/- 14 years; recruited 1989–2004) dialysis patients.


RESULTS
In incident patients: serum albumin was correlated with sex (beta = -0.13; P = 0.02), diabetes mellitus (beta = -0.18; P = 0.004), and urinary albumin excretion (beta = -0.42; P = 0.001) but less so with poor nutritional status (SGA score >1; beta = -0.19; P = 0.001). In prevalent patients, serum albumin was correlated with age (beta = -0.14; P = 0.05), high-sensitivity C-reactive protein (beta = -0.34; P = 0.001), diabetes mellitus (beta = -0.11; P = 0.04), and SGA score >1 (beta = -0.14; P = 0.003). In predicting nutritional status assessed by SGA and other markers, adding serum albumin to models that included age, sex, diabetes, and cardiovascular disease did not significantly increase explanatory power.


CONCLUSIONS
In incident and prevalent dialysis patients,serum albumin correlates poorly with several markers of nutritional status. Thus, its value as a reliable marker of nutritional status in patients with ESRD is limited. In addition, the following inconsistencies between the main text and Tables 1 and 3 are also corrected as follows. (1) In Table 1, the GFR initially written as 6 +/- 3 ml/min per 1.73(2) should be corrected to 6.6 +/- 2.3 ml/min per 1.73(2). (2) On line 11 of page 1448, under the Clinical Correlates of Serum Albumin Concentration section describing the multiple regression models (Table 3), the P value was initially written as“serum albumin was associated with age (beta = -0.14; P = 0.05).” The P value should be corrected to have the same value as that given in Table 3 (beta = -0.14; P = 0.005. [corrected].
Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Thiane
T
Gama-Axelsson
Olof
O
Heimbürger
Peter
P
Stenvinkel
Peter
P
Bárány
Bengt
B
Lindholm
Abdul Rashid
AR
Qureshi
D015502:Absorptiometry, Photon; D000328:Adult; D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D018737:Hand Strength; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D000075462:Serum Albumin, Human; D012737:Sex Factors; D012885:Skinfold Thickness; D013548:Sweden / Q000453:epidemiology
C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D003404:Creatinine; D000075462:Serum Albumin, Human