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http://dx.doi.org/10.4163/jnh.2013.46.6.521

Comparative study of serum levels of albumin and hs-CRPin hemodialysis patients according to protein intake levels  

Lee, Ye Ji (Department of Food and Nutrition, Hanyang University)
Lee, Yeon Joo (Department of Food and Nutrition, Hanyang University)
Oh, Il Hwan (Department of Nephrology, Hanyang University Seoul Hospital)
Lee, Chang Hwa (Department of Nephrology, Hanyang University Seoul Hospital)
Lee, Sang Sun (Department of Food and Nutrition, Hanyang University)
Publication Information
Journal of Nutrition and Health / v.46, no.6, 2013 , pp. 521-530 More about this Journal
Abstract
Protein-energy malnutrition, PEM, and increased hs-CRP level are considered to be associated with increased risk of cardiovascular disease (CVD) in hemodialysis (HD) patients. This is commonly referred to as the vicious circle of malnutrition-inflammation-atherosclerosis cardiovascular disease (MIA syndrome) in chronic kidney disease (CKD). Low protein intake can decrease the serum level of albumin and increase inflammational markers; further, both low serum albumin and high hs-CRP are independent risk factors for all-cause mortality in HD patients. The aim of this study is comparing the serum levels of albumin and hs-CRP in HD patients according to the protein intake levels. The total number of subjects was 60 hemodialysis patients; they were grouped by dietary protein intake: low protein intake group (LPI, protein intake < 1.0 g/kg IBW, 11 men and 19 women) and adequate protein intake group (API, protein intake ${\geq}$ 1.0g/kg IBW, 12 men and 18 women). Blood biochemical parameters, nutrient intake, and dietary behaviors were compared between the LPI and API groups. The LPI group showed a significantly lower serum level of albumin and higher serum level of hs-CRP than the API group (p < 0.05). The LPI group showed a significantly lower intake of most nutrients than the API group (p < 0.05). Index of Nutritional Quality of most nutrients of the LPI and API groups were lower than 1.0. Dietary protein intake was positively correlated with the serum level of albumin (r = 0.306, p < 0.05) and negatively correlated with the serum level of hs-CRP (r = -0.435, p < 0.01). The serum level of hs-CRP was negatively correlated with that of albumin (r = -0.393, p < 0.01). According to these result, serum albumin and hs-CRP in HD patients were influenced by the protein intake levels. To prevent MIA syndrome, it is necessary to improve nutritional status, especially in protein and energy.
Keywords
hemodialysis patients; serum albumin; hs-CRP; protein intake; MIA syndrome;
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1 Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC Jr, Taubert K, Tracy RP, Vinicor F; Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107 (3): 499-511   DOI   ScienceOn
2 Lee HT, Cho S, Lee SH, Kim SR, Kim YH, Seo HJ. Influence of routine calorie and protein intake on nutritional status in stable chronic hemodialysis patients: a 18 months follow-up study. Korean J Nephrol 2002; 21(1): 129-136
3 Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey (KNHANES V-2). Seoul: Ministry of Health and Welfare; 2012
4 K/DOQI guidelines of nutritional in chronic renal failure. Am J Kidney Dis 2000; 35(6): S20-S21, S28-S29, S32-S33, S40-S41, S44-S45
5 Aparicio M, Cano N, Chauveau P, Azar R, Canaud B, Flory A, Laville M, Leverve X. Nutritional status of haemodialysis patients: a French national cooperative study. French Study Group for Nutrition in Dialysis. Nephrol Dial Transplant 1999; 14(7): 1679-1686   DOI   ScienceOn
6 Yoo HS, Woo HJ, Kang ET, Choue RW. Evaluation of nutritional status and changes of biochemical parameters according to protein intake levels in hemodialysis patients. Korean J Nephrol 2000; 19(5): 769-777
7 Friedman AN, Fadem SZ. Reassessment of albumin as a nutritional marker in kidney disease. J Am Soc Nephrol 2010; 21(2): 223-230   DOI   ScienceOn
8 Korean Dietetic Association. Food composition table for chronic kidney disease. Seoul: Korean Dietetic Association; 1997
9 The Korean Nutrition Society. Dietary reference intakes for Koreans, 1st revision. Seoul: The Korean Nutrition Society; 2010
10 Kim IS, Seo EA, Yu HH. A longitudinal study on the change of nutrients and food consumption with advance in age among middle- aged and the elderly. Korean J Community Nutr 1999; 4(3): 394-402
11 Kim MH, Lee JC, Bae YJ. The evaluation study on eating behavior and dietary quality of elderly people residing in Samcheok according to age group. Korean J Community Nutr 2009; 14(5): 495-508
12 Choi KB, Lee YS. Clinical significance of albumin slope in the hemodialysis patients. Korean J Nephrol 2003; 22(6): 713-721
13 Cho JH. The study on nutritional status in Korean hemodialysis patients [dissertation]. Seoul: Ewha Womans University; 2008
14 Thunberg BJ, Swamy AP, Cestero RV. Cross-sectional and longitudinal nutritional measurements in maintenance hemodialysis patients. Am J Clin Nutr 1981; 34(10): 2005-2012
15 Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 2003; 107(3): 391-397   DOI   ScienceOn
16 Fouque D, Vennegoor M, ter Wee P, Wanner C, Basci A, Canaud B, Haage P, Konner K, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Tordoir J, Vanholder R. EBPG guideline on nutrition. Nephrol Dial Transplant 2007; 22 Suppl 2: ii45-ii87
17 Stenvinkel P, Heimbürger O, Lindholm B, Kaysen GA, Bergström J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15(7): 953-960   DOI   ScienceOn
18 Gallar-Ruiz P, Digioia C, Lacalle C, Rodríguez-Villareal I, Laso- Laso N, Hinostroza-Yanahuaya J, Oliet-Pala A, Herrero-Berron JC, Ortega-Marcos O, Ortiz-Libreros M, Mon-Mon C, Cobo- Jaramillo G, Vigil-Medina A. Body composition in patients on haemodialysis: relationship between the type of haemodialysis and inflammatory and nutritional parameters. Nefrologia 2012; 32(4): 467-476
19 Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004; 19(6): 1507-1519   DOI   ScienceOn
20 Wanner C, Metzger T. C-reactive protein a marker for all-cause and cardiovascular mortality in haemodialysis patients. Nephrol Dial Transplant 2002; 17 Suppl 8: 29-32
21 Koch M, Kutkuhn B, Grabensee B, Ritz E. Apolipoprotein A, fibrinogen, age, and history of stroke are predictors of death in dialysed diabetic patients: a prospective study in 412 subjects. Nephrol Dial Transplant 1997; 12(12): 2603-2611   DOI   ScienceOn
22 van der Sande FM, Kooman JP, Leunissen KM. The predictive value of C-reactive protein in end-stage renal disease: is it clinically significant? Blood Purif 2006; 24(4): 335-341   DOI   ScienceOn
23 Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999; 55(2): 648-658   DOI   ScienceOn
24 Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ, Kusek JW, Collins AJ, Levey AS, Sarnak MJ. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 2005; 68(2): 766- 772
25 Kim S, Sohn C, Chae DW. Comparison of nutritional status and inflammational markers in DM and nonDM hemodialysis patients. Korean J Community Nutr 2005; 10(5): 693-699