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

Ye Ji Lee; Yeon Joo Lee; Il Hwan Oh; Chang Hwa Lee; Sang Sun Lee

doi:10.4163/jnh.2013.46.6.521

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

Research Article

Journal of Nutrition and Health 2013; 46(6): 521-530.

Published online: 31 December 2013

DOI: https://doi.org/10.4163/jnh.2013.46.6.521

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

Ye Ji Lee¹, Yeon Joo Lee¹, Il Hwan Oh², Chang Hwa Lee², Sang Sun Lee¹

¹Department of Food and Nutrition, Hanyang University, Seoul 133-791, Korea.

²Department of Nephrology, Hanyang University Seoul Hospital, Seoul 133-792, Korea.

To whom correspondence should be addressed. (leess@hanyang.ac.kr)

Received 20 August 2013 Revised 6 September 2013 Accepted 18 November 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: hemodialysis patients, serum albumin, hs-CRP, protein intake, MIA syndrome

Figures and Tables

Table 1

General characteristics of the subjects according to the protein intake

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

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

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 (%)

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

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 (%)

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

^*: 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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