Assessing the Association of Serum Albumin and Inflammatory Parameters

Background: Hypoalbuminemia and malnutrition have been used nearly synonymousluy. Low serum albumin is the most potent predictor of mortality in hemodialysis patients. However, serum albumin level is also depended on serum level of acute phase proteins or cytokine levels in chronic hemodialysis patienets. Stresses induce different cell type to induce synthesis of positive acute phase proteins (serum amyloid A [SAA], C-reactive protein[CRP]) and suppress synthesis of negative acute phase proteins (albumin, prealbumin). Measurement of cytokine and acute phase protein levels might provide greater insight into the dynamics of small variation in serum albumin level and might find ways to intervene in the pathogenesis events. Method: We collected samples from 165 patients on our hemodialysis unit for assessment of serum albumin, CRP, IGF-1, TNF-α, IL-1ß, IL-6 and SAA at the same time. All patients received hemodialysis more than 6 months and had no acutc serious illness. Result: In paired two-sided t tests, serum albumin was negatively correlated to TNF, IL-6, IL-1, SAA and CRP. IGF-1 was one of nutritional indices and strongly related to serum albumin (P=0.003). Serum albumin level also correlated to some irreversible factors such as diabetic mellitus and aging. Moreover, SAA was strongly correlated to IL-6 (p＜0.001), which was the most potent cytokine in hemodialysis patients. In multivariate regression analysis, IL-6, CRP, age and diabetic mellitus were significant predictors of serum albumin. Conclusion: Chronic inflammation, as evidenced by increased levels of pro-inflammatory cytokines and CRP, is common in hemodialysis patients and may cause malnutrition. Serum albumin level reflected two types malnutrition (with and without a concomitant inflammatory response). Plasma IGF-1 levels also reflected the presence of inflammation and malnutrition.

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