Original Research
Longitudinal Measures of Serum Albumin and Prealbumin Concentrations in Incident Dialysis Patients: The Comprehensive Dialysis Study

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Objective

Serum albumin and prealbumin concentrations are strongly associated with the risk of death in dialysis patients. Our study examined the association among demographic characteristics, body composition, comorbidities, dialysis modality and access, inflammation, and longitudinal measures of albumin and prealbumin concentrations in incident dialysis patients.

Design, Setting, Subjects, and Outcome Measures

The Comprehensive Dialysis Study is a prospective cohort study of incident dialysis patients; in this report, we examined the data from 266 Nutrition substudy participants who donated serum. The independent variables of interest were baseline age, sex, race, Quetélet's (body mass) index, dialysis modality and access, diabetes, heart failure, atherosclerotic vascular disease, serum creatinine level, and longitudinal measures of C-reactive protein. The outcomes of interest (dependent variables) were longitudinal measures of albumin and prealbumin concentrations, recorded at study entry and thereafter every 3 months for 1 year.

Results

In multivariable mixed linear models, female sex, peritoneal dialysis, hemodialysis with a catheter, and higher C-reactive protein concentrations were associated with lower serum albumin concentrations, and serum albumin concentrations increased slightly over the year. In comparison, prealbumin concentrations did not significantly change over time; female sex, lower body mass index, diabetes, atherosclerotic vascular disease, and higher C-reactive protein concentrations were associated with lower prealbumin concentrations. Serum creatinine had a curvilinear relation with serum albumin and prealbumin.

Conclusions

Serum albumin level increases early in the course of dialysis, whereas prealbumin level does not, and the predictors of serum concentrations differ at any given time. Further understanding of the mechanisms underlying differences between albumin and prealbumin kinetics in dialysis patients may lead to an improved approach to the management of protein–energy wasting.

Section snippets

Study Participants

The CDS is a prospective cohort study of adults with end-stage renal disease (ESRD) in whom maintenance hemodialysis or peritoneal dialysis was newly initiated in the United States; participants were enrolled between September 2005 and June 2007. The CDS was designed to examine nutrition, functional status/physical activity, and the quality of life in incident dialysis patients. The study design and cohort recruitment have been previously described in detail.11 Briefly, a sample of 335 dialysis

Results

A total of 266 CDS Nutrition substudy participants with laboratory measures were included in our study; these participants were from 56 participating dialysis facilities. The mean age of the participants was 62 years; 55% were male, 71% were white, 68% were on hemodialysis, with a catheter as the vascular access, and 8% were on peritoneal dialysis (Table 1). The cohort was characterized by a high prevalence of diabetes, heart failure, and ASVD. The median time from dialysis initiation to the

Discussion

In our study of longitudinal serum albumin and prealbumin concentrations, we found that serum albumin concentrations increased, whereas prealbumin concentrations did not change over time on average. Sex, dialysis modality, dialysis access type, serum creatinine level, and inflammation were associated with the serum albumin concentrations over time. Although some of the correlates of prealbumin were the same as those observed for albumin, prealbumin concentrations were also associated with BMI,

Practical Application

The findings from our study highlight that albumin and prealbumin levels do not change in parallel during the early course of dialysis and that the clinical correlates of each protein differ. Although albumin and prealbumin levels each decreases in response to inflammation and to significant protein malnutrition, they respond differently to correction of malnutrition and external loss. Further examination of mechanisms underlying differences between albumin and prealbumin kinetics may lead to

Acknowledgments

The manuscript contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. The interpretation and reporting of the data presented here are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the United States government.

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Support: This publication was made possible by grant and contract number N01-DK-7-0005 from the National Institutes of Diabetes and Digestive and Kidney Diseases, and grant number UL1 RR024146 from the National Center for Research Resources (NCRR).

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