Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis.

Hypoalbuminemia results when compensatory mechanisms are unable to keep pace with derangements in catabolism/loss and/or decreased synthesis of albumin. Across many disease states, including chronic kidney disease (CKD), hypoalbuminemia is a well-established, independent risk factor for adverse outcomes, including mortality. In the setting of CKD, reduced serum albumin concentrations are often a manifestation of protein-energy wasting, a state of metabolic and nutritional alterations resulting in reduced protein and energy stores. The progression of CKD to kidney failure and the initiation of maintenance hemodialysis (HD) further predisposes an already at-risk population toward hypoalbuminemia such that approximately 60% of HD patients have albumin concentrations <4.0 g/dl. Albumin loss into the dialysate through the dialyzer appears to be a potentially modifiable cause of hypoalbuminemia in some patients. A group of newer dialyzers for maintenance HD-sometimes termed protein-leaking or medium cut-off membranes-aim to improve clearance of middle molecules (vs high flux dialyzers) but are associated with increased albumin losses. In this article, we will examine the impact of dialyzer selection on albumin losses during conventional HD, including the clinical relevance of such losses on serum albumin levels. Data on the clinical relevance of albumin losses during dialysis and current gaps in the evidence base are also discussed.

Informations de copyright

© 2021 Kalantar-Zadeh et al.

Déclaration de conflit d'intérêts

KK-Z has received honoraria and/or support from Abbott, AbbVie, Alexion, American Society of Nephrology, Amgen, AstraZeneca, AVEO, Chugai, DaVita, Fresenius, Fresenius Kabi, Genentech, Haymarket Media, Hospira, International Federation of Kidney Foundations, International Society for Hemodialysis, International Society of Renal Nutrition and Metabolism, Japanese Society for Dialysis Therapy, Keryx, National Institutes of Health, National Kidney Foundation, Novartis, OPKO, Pfizer, Relypsa, Resverlogix, Sandoz, Sanofi, Shire, UpToDate, Vifor, ZS Pharma, and Zucker School of Medicine. LHF, CM, and MSA are employees of Fresenius Medical Care Renal Therapies Group. CM is a stockholder in Fresenius Medical Care. JB is an employee of Fresenius Kidney Care and consultant to Fresenius Medical Care Renal Therapies Group. The authors report no other conflicts of interest in this work.