Journal List > J Nutr Health > v.46(6) > 1081318

Lee, Lee, Oh, Lee, and Lee: Comparative study of serum levels of albumin and hs-CRP in hemodialysis patients according to protein intake levels

Abstract

Protein-energy malnutrition, PEM, and increased hs-CRP level are considered to be associated with increased risk of cardiovascular disease (CVD) in hemodialysis (HD) patients. This is commonly referred to as the vicious circle of malnutrition-inflammation-atherosclerosis cardiovascular disease (MIA syndrome) in chronic kidney disease (CKD). Low protein intake can decrease the serum level of albumin and increase inflammational markers; further, both low serum albumin and high hs-CRP are independent risk factors for all-cause mortality in HD patients. The aim of this study is comparing the serum levels of albumin and hs-CRP in HD patients according to the protein intake levels. The total number of subjects was 60 hemodialysis patients; they were grouped by dietary protein intake: low protein intake group (LPI, protein intake < 1.0 g/kg IBW, 11 men and 19 women) and adequate protein intake group (API, protein intake ≥ 1.0 g/kg IBW, 12 men and 18 women). Blood biochemical parameters, nutrient intake, and dietary behaviors were compared between the LPI and API groups. The LPI group showed a significantly lower serum level of albumin and higher serum level of hs-CRP than the API group (p < 0.05). The LPI group showed a significantly lower intake of most nutrients than the API group (p < 0.05). Index of Nutritional Quality of most nutrients of the LPI and API groups were lower than 1.0. Dietary protein intake was positively correlated with the serum level of albumin (r = 0.306, p < 0.05) and negatively correlated with the serum level of hs-CRP (r = -0.435, p < 0.01). The serum level of hs-CRP was negatively correlated with that of albumin (r = -0.393, p < 0.01). According to these result, serum albumin and hs-CRP in HD patients were influenced by the protein intake levels. To prevent MIA syndrome, it is necessary to improve nutritional status, especially in protein and energy.

Figures and Tables

Table 1
General characteristics of the subjects according to the protein intake
jnh-46-521-i001

LPI: Low protein intake (<1.0 g protein/kg IBW), API: Adequate protein intake (≥1.0 g protein/kg IBW)

1) Mean ± SD 2) p value by independent t-test 3) p value by χ2-test 4) BMI: body mass index 5) PIBW: percent ideal body weight 6) HD: hemodialysis 7) rHuEPO: recombinant human erythropoietin

Table 2
Blood biochemical parameters of the subjects according to the protein intake
jnh-46-521-i002

LPI: Low protein intake (<1.0 g protein/kg IBW), API: Adequate protein intake (≥1.0 g protein/kg IBW)

1) Mean ± SD 2) p value by ANCOVA after adjusting for age, HD duration and intake of medications 3) hs-CRP: high-sensitivity C-reactive protein 4) nPCR: normalized protein catabolic rate 5) BUN: blood urea nitrogen 6) TG: triglyceride 7) TC: total cholesterol 8) HDL-C: high density lipoprotein cholesterol 9) LDL-C: low density lipoprotein cholesterol 10) TIBC: total iron binding capacity

Table 3
Nutrient intakes and frequency of protein foods of the subjects according to the protein intake
jnh-46-521-i003

LPI; Low protein intake (<1.0 g protein/kg IBW), API: Adequate protein intake (≥1.0 g protein/kg IBW)

1) Mean ± SD 2) p value by ANCOVA after adjusting for gender, age and HD duration 3) CHO: carbohydrate

Table 4
Assessment of nutrient intakes less than RNI1) and EAR2) of the subjects according to the protein intake n (%)
jnh-46-521-i004

LPI: Low protein intake (<1.0 g protein/kg IBW), API: Adequate protein intake (≥1.0 g protein/kg IBW)

1) RNI: recommended nutrient intake of The Korean Dietetic Association (KDA) 2) EAR: estimated average requirement 3) p value by χ2-test

Table 5
Index of nutritional quality of the subjects according to the protein intake
jnh-46-521-i005

LPI: Low protein intake (<1.0 g protein/kg IBW), API: Adequate protein intake (≥1.0 g protein/kg IBW)

1) Mean ± SD 2) p value by independent t-test

Table 6
Korean's Dietary Diversity Score (KDDS) and food group intake pattern (CMVDO) of the subjects according to the protein intake n (%)
jnh-46-521-i006

LPI: Low protein intake (<1.0 g protein/kg IBW), API: Adequate protein intake (≥1.0 g protein/kg IBW)

1) Mean ± SD 2) p value by independent t-test 3) p value by χ2-test

Table 7
Correlation between dietary intakes and blood biochemical parameters of the subjects
jnh-46-521-i007

*: p < 0.05, **: p < 0.01, ***: p < 0.001, p value by partial correlation after adjusting for age, HD duration and intake of medications 1) hs-CRP: high sensitivity C-reactive protein, 2) Alb: albumin, 3) Hb: hemoglobin, 4) Hct: hematocrit, 5) TG: triglyceride, 6) TC: total cholesterol

Notes

This work was supported by grants of the National Research Foundation of Korea (2012R1A1A2008077).

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