Serum Albumin as Predictor of Nutritional Status in Patients with ESRD

Background and objectives Serum albumin is a widely used biomarker of nutritional status in patients with CKD; however, its usefulness is debated. This study investigated serum albumin and its correlation with several markers of nutritional status in incident and prevalent dialysis patients. Design, setting, participants, & measurements In a cross-sectional study, serum albumin (bromocresol purple), and other biochemical (serum creatinine), clinical (subjective global assessment [SGA]), anthropometric (handgrip strength; skinfold thicknesses), and densitometry (dual-energy x-ray absorptiometry) markers of nutritional status were assessed in 458 incident (61% male; mean age, 54 +/- 13 years; GFR, 6.6 +/- 0.3 ml/min per 1.73 m(2); recruited 1994-2010) and 383 prevalent (56% male; mean age, 62 +/- 14 years; recruited 1989-2004) dialysis patients. Results In incident patients, serum albumin was correlated with age (beta =-0.15; P<0.001), diabetes (beta=-0.30; P<0.001), high-sensitivity C-reactive protein (beta =-0.37; P<0.001), and urinary albumin excretion (beta=-0.38; P<0.001) but less so with poor nutritional status (SGA score > 1; beta=-0.19; P<0.001). In prevalent patients, serum albumin was correlated with age (beta=-0.15; P<0.001), high-sensitivity C-reactive protein (beta=-0.30; P<0.001), diabetes (beta=-0.31; P<0.001), and SGA score > 1 (beta=-0.16; P<0.001). In predicting nutritional status assessed by SGA and other markers, adding serum albumin to models that included age, sex, diabetes, and cardiovascular disease did not significantly increase explanatory power. Conclusions In incident and prevalent dialysis patients, serum albumin correlates poorly with several markers of nutritional status. Thus, its value as a reliable marker of nutritional status in patients with ESRD is limited. Clin J Am Soc Nephrol 7: 1446-1453, 2012. doi: 10.2215/CJN.10251011