THE DECLINE IN SERUM-ALBUMIN AFTER CONVERSION TO HIGH-FLUX, HIGH-EFFICIENCY DIALYSIS

Hypoalbuminemia among chronic hemodialysis patients is recognized as a poor prognostic sign. We observed that many of our chronic patients h ad a progressive decrease in their plasma albumin concentrations after they were converted to high flux, high efficiency dialysis from conve ntional dialysis mode. This change occurred in the absence of changes in the KT/V and protein catabolic rate (pcr) normalized to body mass. When nitrogen losses were measured, we found no difference in the dial ystate concentrations of urea, alpha amino nitrogen, uric acid, or tot al nitrogen when high flux polysulfone was compared with high efficien cy Cuprophan. While urea was the predominant nitrogen solute in all di alysate samples, there were some with a large gap between total and ur ea nitrogen. Alpha amino nitrogen losses, expressed as leucine equival ents, were substantial, ranging from 8.4 to 9.8 g/3.5 h dialysis treat ment. We believe that the increased losses of nitrogen experienced by patients after their conversion to a more efficient method of dialysis and not compensated for by a spontaneous increased intake of protein led to the observed fall in plasma albumin. Both urea and amino acid n itrogen losses need to be accounted for when achievement of higher KT/ V dialysis is pursued.