Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Dec 11:16:211.
doi: 10.1186/s12882-015-0209-z.

Gastrointestinal symptoms, inflammation and hypoalbuminemia in chronic kidney disease patients: a cross-sectional study

Xuehan Zhang  1   2 , Nisha Bansal  3 , Alan S Go  4 , Chi-Yuan Hsu  5   6
Affiliations
Observational Study

Gastrointestinal symptoms, inflammation and hypoalbuminemia in chronic kidney disease patients: a cross-sectional study

Xuehan Zhang et al. BMC Nephrol. .

Abstract

Background: Few studies have focused on investigating hypoalbuminemia in patients during earlier stages of chronic kidney disease (CKD). In particular, little is known about the role of gastrointestinal (GI) symptoms. Our goal in this paper is to study how GI symptoms relate to serum albumin levels in CKD, especially in the context of and compared with inflammation.

Methods: We performed a cross-sectional study of 3599 patients with chronic kidney disease enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. All subjects were asked to complete the Modification of Diet in Renal Disease (MDRD) study patient symptom form. Our main predictor is GI symptom score. Serum level of C-reactive protein (CRP) was measured as well. Main outcome measures are serum albumin levels and prevalence of hypoalbuminemia.

Results: Of the participants assessed, mean serum albumin was 3.95 ± 0.46 g/dL; 12.7 % had hypoalbuminemia. Patients with lower estimated glomerular filtration rate (eGFR) were likely to have more GI symptoms (apparent at an eGFR <45 ml/min/1.73 m(2)). Patients with worse GI symptoms had lower dietary protein intake. GI symptoms, like inflammation, were risk factors for lower serum albumin levels. However, adding GI symptom score or CRP into the multivariable regression analysis, did not attenuate the association between lower eGFR and lower albumin or hypoalbuminemia.

Conclusions: Increased prevalence of GI symptoms become apparent among CKD patients at relatively high eGFR levels (45 ml/min/1.73 m(2)), long before ESRD. Patients with more severe GI symptoms scores are more likely to have hypoalbuminemia. But our data do not support GI symptoms/decreased protein intake or inflammation as being the main determinants of serum albumin level in CKD patients.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Relationship between reduced kidney function, serum albumin levels, GI symptoms, dietary protein intake and inflammation
Fig. 2
Fig. 2
Prevalence of GI symptoms across eGFR categories. The * identifies P < 0.01 for a chi-square test among the groups with different eGFR values
See this image and copyright information in PMC

References

    1. Lowrie EG, Lew NL. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990;15(5):458–482. doi: 10.1016/S0272-6386(12)70364-5. - DOI - PubMed
    1. Kaysen GA, Dubin JA, Muller HG, Rosales LM, Levin NW. The acute-phase response varies with time and predicts serum albumin levels in hemodialysis patients. Kidney Int. 2000;58(1):346–352. doi: 10.1046/j.1523-1755.2000.00172.x. - DOI - PubMed
    1. Avram MM, Goldwasser P, Erroa M, Fein PA. Predictors of survival in continuous ambulatory peritoneal dialysis patients: The importance of prealbumin and other nutritional and metabolic markers. Am J Kidney Dis. 1994;23(1):91–98. doi: 10.1016/S0272-6386(12)80817-1. - DOI - PubMed
    1. Weijenberg MP, Feskens EJ, Souverijn JH, Kromhout D. Serum albumin, coronary heart disease risk, and mortality in an elderly cohort. Epidemiology. 1997;8(1):87–92. doi: 10.1097/00001648-199701000-00014. - DOI - PubMed
    1. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36–42. doi: 10.1001/archsurg.134.1.36. - DOI - PubMed

Publication types