Serum albumin: its significance in patients with ESRD

Hypoalbuminemia is a major risk factor for morbidity and mortality in the ESRD population. The Core Indicators Project notes that the serum albumin value is a measure of the patient's nutritional status. Since 1994 every outcome parameter of the Core Indicators Project has shown improvement except for the serum albumin measurement. While the serum albumin level is a measure of the visceral protein pool size, a decrease in albumin synthesis is due to more than poor nutritional intake (in part related to inadequate dialysis). Acute-phase reactants and the plasma volume status are other major factors that impact on serum albumin determination. Plasma volume expansion, albumin redistribution, exogenous loss (in peritoneal dialysis patients), and decreased albumin synthesis all contribute to hypoalbuminemia. Understanding the cause (s) of hypoalbuminemia will allow us to target treatment modalities directed at correcting the hypoalbuminemia. It is still unknown if the serum albumin can be effectively raised in the chronic dialysis patient. Also unknown is whether an increase in the serum albumin level can alter long-term morbidity and mortality. We should not be using serum albumin as an indicator of adequate dialysis or nutritional status since the causes ofhypoalbuminemia are multifactorial. It is recommended that the serum albumin level be eliminated as an indicator of nutritional status in the ESRD patient.