Prokinetic agents increase plasma albumin in hypoalbuminemic chronic dialysis patients with delayed gastric emptying

Hypoalbuminemia is a surrogate of malnutrition in patients with end-stage r enal disease undergoing chronic dialysis and commonly improves with prescri ption of adequate nutrition and dialysis. Nevertheless, some patients remai n hypoalbuminemic for poorly understood reasons. We tested the hypotheses t hat chronic dialysis patients who remain hypoalbuminemic despite prescripti on of adequate nutrition and dialysis (1) have delayed gastric emptying, an d (2) that prokinetic agents will increase plasma albumin (P-alb) levels in patients with delayed gastric emptying, We retrospectively identified 99 o f 343 hemodialysis and peritoneal dialysis patients with hypoalbuminuria (P -alb < 3.5 mg/dL) and studied those who did not (hypoalbuminemic, n = 15) a nd did (normoalbuminemic, n = 15) increase their P-alb levels over the subs equent 6 months and met inclusion and exclusion criteria. Gastrointestinal symptom scores determined by an administered questionnaire were not differe nt in hypoalbuminemic and normoalbuminemic patients. Conversely, the half-t ime (T-1/2) for radionuclide gastric emptying was longer in hypoalbuminemic than normoalbuminemic patients (74.5 +/- 7.4 versus 46.7 +/- 4.6 minutes; P < 0.004). Hypoalbuminemic patients were prescribed prokinetics and follow ed prospectively for 6 months, during which time gastric Tin decreased to 5 3.9 +/- 3.3 minutes (P < 0.01 versus initial) and P-alb increased from 3.1 +/- 0.2 to 3.5 +/- 0.2 mg/dL (P < 0.004). The net increase in P-alb level c orrelated with the net decrease in gastric T-1/2 (P = 0.4; P < 0.04) by lin ear regression. The data show that some persistently hypoalbuminemic chroni c dialysis patients have poor gastric emptying and increase their P-alb lev els in response to prokinetic agents. (C) 2001 by the National Kidney Found ation, Inc.