Improvement of Albumin Control in Hemodialysis Patients—What Is Possible?

Murat H Sipahioglu, Nathan W Levin
US Nephrology, 2008;3(2):54-58
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Oral nutritional supplementation is more physiological and easier to use, but in earlier studies54,55 it was not strikingly effective in improving albumin levels in hypoalbuminemic HD patients. However, two recent studies reported that oral nutritional supplements have a strong anabolic response and increase albumin levels in HD patients, especially when administered during HD.52,56 Caglar et al.57 studied 85 malnourished dialysis patients who were given an oral nutritional supplement specifically formulated for HD patients over a period of six months during dialysis. Serum albumin concentration significantly increased, from 3.33±0.32g/dl at baseline to 3.65±0.26g/dl at month six (p<0.0001). A systematic review of 18 studies assessed that enteral (oral or tube feeding) nutritional support increased serum albumin concentration by 0.23g/dl, with little effect on serum electrolyte status.58 In the large nutritional study from Cano et al.52 mentioned above, the control group received oral nutrition only (for one year). Albumin levels were increased in both enteral and parenteral groups (p<0.01), and addition of IDPN did not add anything significant.

Recombinant Human Growth Hormone

Short-term studies in patients with chronic renal failure showed that growth hormone (GH) stimulates protein anabolism and improves indicators of nutrition, especially when given along with nutritional supplementation.59,60 Schulman et al.59 studied the use of recombinant human GH (rHuGH) in potentiating the effects of IDPN. During six weeks of IDPN, serum albumin increased by 0.3g/dl. During the subsequent six weeks, when GH was added to IDPN, serum albumin levels rose by an additional 0.3g/dl (p<0.04). Improved protein metabolism may result from the increased ability to utilize essential amino acids.61 However, long-term nutritional benefits were not observed in a study in which GH was administered for one year.62 Long-term randomized studies are needed to assess the long-term effect of GH.

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