Document Detail


Serum albumin is strongly associated with erythropoietin sensitivity in hemodialysis patients.
MedLine Citation:
PMID:  18045859     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: In hemodialysis patients, the hematological response to erythropoietin (epo) is variable and clinical factors that explain this variability are incompletely understood. We tested the hypothesis that the variability in hemoglobin (Hgb) response (epo sensitivity) is determined by key nutritional, inflammation, and oxidative stress markers.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Eighty-two consecutive patients on hemodialysis had 3 consecutive monthly predialysis evaluations of Hgb, total white blood cell (WBC) count, serum albumin, malondialdehyde (MDA), and monocyte chemoattractant protein-1 (MCP1). We analyzed the time course of Hgb in relationship to serum albumin, WBC, MDA, MCP1, epo and iron administration, and tests of iron sufficiency in a linear growth curve model.
RESULTS: Subjects with higher Hgb had a fall in Hgb and vice versa, regressing to a mean Hgb (SD) of 11.8 g/dl (1.8 g/dl). Whereas the average slope of Hgb was flat, the SD of slopes was 0.63 g/dl, which explained 39% of the variance in Hgb. Nonuse of epo was associated with a mean Hgb change of -0.18 g/dl (95% confidence interval [CI] -0.26 to -0.10) per 10,000 IU epo/mo (P < 0.05). Epo use was associated with steeper rate of change at 0.04 g/dl per mo per 10,000 IU (95% CI 0.01 to 0.07) (P < 0.01). Hgb at baseline was 0.73 g/dl higher for each 1-g/dl increase in albumin, and the rate of change increased by 0.49 g/dl per mo for each 1-g/dl increase in albumin concentration. WBC, MDA, or MCP1 had no role in predicting the baseline Hgb or its change over time.
CONCLUSIONS: Serum albumin concentration is an important predictor of both baseline Hgb and epo sensitivity in chronic hemodialysis patients. Factors that improve serum albumin may also improve Hgb in hemodialysis patients.
Authors:
Rajiv Agarwal; Joyce L Davis; Linda Smith
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2007-11-28
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  3     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-07     Completed Date:  2008-01-30     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-104     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and the Richard L. RoudebushVA Medical Center, Indianapolis, Indiana 46202, USA. ragarwal@iupui.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anemia / blood,  drug therapy*
Biological Markers
Chemokine CCL2 / blood
Erythropoietin / therapeutic use*
Female
Hemoglobins / metabolism
Humans
Inflammation / blood
Kidney Failure, Chronic / blood,  complications*
Leukocyte Count
Male
Malondialdehyde / blood
Middle Aged
Oxidative Stress
Predictive Value of Tests
Prospective Studies
Renal Dialysis*
Serum Albumin / metabolism*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/CCL2 protein, human; 0/Chemokine CCL2; 0/Hemoglobins; 0/Serum Albumin; 11096-26-7/Erythropoietin; 542-78-9/Malondialdehyde
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