Bergstrom J, Heimburger O, Lindholm B, Qureshi AR
Elevated serum C-reactive protein is a strong predictor of
increased mortality and low serum albumin in
hemodialysis patients
International Society of Blood Purification
Blood Purif
(Sep) 13:(supp.1)49 1995
Because many groups have corroborated the finding that low serum albumin
concentrations are
associated with increased risk of death in HD patients, Bergstrom et al
sought to define variables
that might affect serum albumin, such as nutrition, and non-nutritional
factors like age,
overhydration, increased capillary permeability and inflammatory conditions.
Nutritional status
by subjective global assessment (SGA), anthropometric, biochemical markers
and C-reactive
protein were measured on non- dialysis days in 126 patients, followed for 4
years.
Normal nourishment was present in 37% of the HD patients with a mean albumin
concentration
of 3.5 g/dl and CRP of 18 mg/dl. Fifty-two percent were mildly malnourished
by SGA with
albumin of 3.2 g/dl and CRP of 21 mg/dl. Thirteen percent were severely
malnourished by
SGA with albumin of 3.0 and CRP of 26. CRP was increased with age, hence an
age-associated
co-morbidity. Age, SGA and CRP regressed well against albumin. CRP and
albumin were
inversely correlated. In a Cox proportional hazard model CRP is the
strongest predictive factor
for death, such that albumin falls out as a predictor in the model. Non-
nutritional factors
influence serum albumin and probably should be followed routinely.
(T.A. Golper)
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International Society of Blood Purification
CRF by organ system :
Nutrition