Prevalence Of Low Serum Albumin And The Association With Metabolic Acidosis And Micro Inflammation In Chronic Kidney Disease

Objective: Hypoalbuminemia is a risk factors of poor prognosis of patients withchronic kidney disease (CKD), through the analysis of CKD1-4stage patients’ clinicaldata, to understand metabolic acidosis and micro inflammation and their associationwith low serum albumin in chronic kidney disease..Methods: We analyzed data from178subjects over the age of20who werehospitalized in the Second Affiliated Hospital of Dalian Medical University from June2011to march2012. All of the patients’ eGFR were greater than15ml/min/1.73m2.Respectively, we selected the patients of stage1-4according to the American kidneyfoundation K/DOQI chronic kidney disease standard: CKD1(n=62) eGFR:90-150ml/min/1.73m2, CKD2(n=51) eGFR:60-89ml/min/1.73m2, CKD3(n=43) eGFR:30-59ml/min/1.73m2, CKD4(n=22people) eGFR:15-29ml/min/1.73m2. Detectionindicators include:1. The human body measure: body weight, height, body mass index(BMI);2. Serological index: determination of hemoglobin, creatinine (Scr), blood ureanitrogen, serum albumin (Alb), cholesterol (CHOL), triglycerides(TG);3. Arterial bloodgas analysis: determine serum HCO3-concentration and serum anion clearance;4.Dietary investigation:record three days diet, using food software, and the calculation foreach kilogram of body weight daily average of energy (DEI) and protein (DPI);5. Theinflammation index: by immune method analyze c-reactive protein (CRP);6. Urinecheck: random urine protein and creatinine ratio, and the part of the correlation analysis.Results: One hundred and seventy-eight patients of chronic kidney disease whosemean age is50.2±11.56years, include80male and98female ones were analyzed. Thefour groups of the CKD1-4had statistically significant differences (P <0.05) in age, female gender, BMI, the percentage of diabetic patients, the percentage of hypertensivepatients, the daily per kilogram of body weight energy intake and the daily per kilogramof body weight of protein intake. With the decline of eGFR level, the incidence ofhypoproteinemia increased, but the decline of eGFR level may not be the independentrisk factors of the hypoproteinemia after additional adjustment for confounders. Thedecline of serum HCO3-concentration and the increase of CRP levels had significantdifferences (P<0.05) between the four groups of the CKD1-4. The average serumalbumin factor analysis showed that with the decline in blood bicarbonate concentrationand the eGFR as well as the urine protein/urine creatinine (≥1000mg/g), there was adownward trend in average serum albumin level; while there is a downward trend inserum albumin level in response to the increasing CRP levels. All of these changes werestatistically significant (P <0.05). The analysis of related risk factors ofhypoproteinemia showed that there would be independent risk factors (OR values>1.0,all P <0.05) of the hypoproteinemia in increased age, female, lower serum bicarbonateconcentration, and elevated CRP levels as well as random urine protein/urinecreatinine (≥1000mg/g). In addition, the analysis of the risk factors of diabetic andnondiabetic patients with hypoalbuminemia showed that there would be independentrisk factors(OR values>1.0, all P <0.05) in the hypoalbuminemia of the two group inwomen, the decreased of serum HCO3-concentration, CRP elevation, and randomurinary protein to creatinine ratio (≥1000mg/g).Conclusion: The increased age, female, random urine protein and creatinine ratioquartile (≥1000mg/g), serum HCO3-reduce and CRP rise may be independent riskfactors for chronic kidney disease1-4patients with hypoalbuminemia; It also showsthat the metabolic acidosis and micro inflammation may affect the occurrence ofhypoalbuminemia.