Kaysen GA, Rathore V, Depner TA
C reactive protein and serum amyloid A levels predict serum
albumin levels in hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1486 1996
Following clues obtained from a more focused study of albumin turnover in
hemodialyzed patients reported one year ago, this study examined
inflammatory markers in a larger cross section of patients in the same
dialysis center. Hepatic synthesis of C-reactive protein, a large
polypeptide that reacts with pneumococcal cell membrane (origin of the term
"C-reactive") is markedly stimulated by inflammatory states. Synthesis of
serum amyloid A, the serum marker for secondary amyloidosis, is also
markedly stimulated by inflammation, but albumin synthesis is reduced.
Malnutrition also reduces albumin synthesis but does not increase the
inflammatory markers.
In this study the strong correlation between serum albumin concentration
and both C-reactive protein and serum amyloid A suggested that inflammation
was a cause of hypoalbuminemia in these patients. The weaker but
significant correlation between serum albumin and normalized protein
catabolic rate (PCRn) suggested an independent but supplemental effect of
protein malnutrition.
Comment: Malnutrition was not disproved as a cause of
hypoalbuminemia in these hemodialyzed patients but inflammation could be a
more potent cause, especially since hypoalbuminemia often fails to respond
to nutritional therapy alone. The nature of the inflammatory process could
be diverse but is poorly understood at the present time.
(Thomas A. Depner, M.D., University of California at Davis)
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Am Soc Nephrol
CRF by organ system :
Nutrition