Qureshi AR, Anderstam B, Danielsson A, Gutierrez A, Lindholm B, Bergstrom J
Predictors of malnutrition in maintenance hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Nov) 6:586 1995

Only 36% of 128 ESRD patients maintained with HD had normal nutritional parameters by subjective global assessment and 13% had moderate to severe protein-energy malnutrition. Those with severe malnutrition by subjective assessment also had reduced body mass index, skinfold thickness, arm circumference, serum albumin, and nPCR. Serum albumin as well as plasma amino acid levels correlated with the nutritional status. However, serum albumin also correlated equally well, although negatively, with serum levels of C-reactive protein suggesting that inflammation or tissue injury was equally if not more responsible for low serum albumin levels in many patients.

Comment: This cross sectional study supplements the longitudinal study by the same investigators (218/573) that showed a correlation between C-reactive protein and survival. Low serum albumin levels correlate with impending death but the correlation may be nonspecific. Many serious disease states (with the exception of uremia) cause an acute phase response by the liver, lowering the serum albumin and raising levels of acute phase reactants such as C-reactive protein, serum amyloid A, and fibrinogen. It remains possible, however that an inflammatory or "acute phase" response to some component of the dialysis itself may contribute to morbidity. (Depner)

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Am Soc Nephrol
CRF by organ system : Nutrition