Serum albumin: Its significance in patients with ESRD

Hypoalbuminemia is a major risk factor for morbidity and mortality in the E SRD population. The Core Indicators Project notes that the serum albumin va lue is a measure of the patient's nutritional status. Since 1994 every outc ome parameter of the Core Indicators Project has shown improvement except f or the serum albumin measurement. While the serum albumin level is a measur e of the visceral protein pool size, a decrease in albumin synthesis is due to more than poor nutritional intake (in part related to inadequate dialys is). Acute-phase reactants and the plasma volume status are other major fac tors that impact on serum albumin determination. Plasma volume expansion, a lbumin redistribution, exogenous loss (in peritoneal dialysis patients), an d decreased albumin synthesis all contribute to hypoalbuminemia. Understand ing the cause (s) of hypoalbuminemia will allow us to target treatment moda lities directed at correcting the hypoalbuminemia. It is still unknown if t he serum albumin can be effectively raised in the chronic dialysis patient. Also unknown is whether an increase in the serum albumin level can alter l ongterm morbidity and mortality. We should not be using serum albumin as an indicator of adequate dialysis or nutritional status since the causes of h ypoalbuminemia are multifactorial. It is recommended that the serum albumin level be eliminated as an indicator of nutritional status in the ESRD pati ent.