Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis

Figures & data

Figure 1 Relative risk of death by albumin level among 19,746 patients receiving in-center hemodialysis. Data from Lowrie EG, Lew NL.¹⁹ Data presented as crude risk ratios. *P < 0.05 vs reference (ie, albumin of 4.01–4.50 g/dl).

Figure 2 Derangements in albumin homeostasis in patients undergoing hemodialysis. Data from these studies.^{1,5,11,17,29,33–35}

Figure 3 Change in serum albumin levels after 6 months of hemodialysis with different high flux dialyzers among 156 patients with baseline hypoalbuminemia (≤3.5 g/dl). Data from Zhou et al.⁵⁷

Table 1 Longitudinal Changes in Serum Albumin Concentrations in Studies of Protein-Leaking Dialyzers

Study Author (Yr/Country)	Patients (N) Study Duration	Protein-Leaking Dialyzer		High Flux Dialyzer
		Baseline Serum Albumin, g/dl (Dialyzer Studied)	Change in Serum Albumin, g/dl	Baseline Serum Albumin, g/dl (Dialyzer Studied)	Change in Serum Albumin, g/dl
Zickler et al^Citation64 (2017/Germany)	48 4 + 8 wk (extension)	3.70 (0.36) (MCO-Ci 400)	▼ 0.17 (4 wk) ▼ 0.06 (12 wk)	3.66 (0.32) (Revaclear 400 dialyzer)	▲ 0.09 (4 wk) ▲ 0.12 (12 wk)
Cozzolino et al^Citation65 (2019/Italy)	20 3 mo	Group A 3.75 (3.10 to 3.80) Group B 3.80 (3.30 to 4.20) (Theranova 400)	Group A ▲ 0.04 (0.175 to 0.375) Group B ▼ 0.45 (–0.575 to –0.05)	Group A 3.6 (3.35 to 3.80) Group B 3.47 (3.05 to 3.80) (FX8, FX10, FX80, FX 100, BK1.6, BG2.1)	Group A ▲ 0.1 (–0.525 to 0.175) Group B ▲ 0.34 (0.125 to 0.40)
Belmouaz et al^Citation66 (2020/France)	40 6 mo	3.73 (0.31) (Theranova 500)	▼ 0.04	3.73 (0.31) (Elisio™-21H)	▲ 0.09
Krishnasamy et al^Citation71 (2020/Australia)	89 24 wk	3.58 (0.39) (Theranova 400)	▼ 0.07 (–1.5 to 0.1)*	No control group	No control group
Lim et al^Citation69 (2020/South Korea)	49 12 wk	4.11 (0.38) (Theranova 400)	▼ 0.13	4.06 (0.27) (FX CorDiax 60 or 80)	▼ 0.02
Sevinc et al^Citation70 (2020/Turkey)	52 3 mo	3.88 (3.71 to 4.04) (Theranova 500)	▼ 0.26	3.75 (3.59 to 3.95) (FX CorDiax 80)	▲ 0.03
Bunch et al^Citation67 (2020/Colombia)	992 12 mo	4.05 (4.04 to 4.07) (Theranova MCO dialyzer)	▼ 0.14 (3 mo) ▼ 0.07 (12 mo)	No control group	No control group
Yeter et al^Citation68 (2020/Turkey)	42 6 mo	4.0 (0.25) (Theranova 400)	▼ 0.16	3.96 (0.23) (Fresenius CorDiax 800 HDF)	▼ 0.07

Notes: Data listed as mean, mean (SD), or median (interquartile range) unless otherwise noted. *Data listed as mean (95% CI). ▼=reduction from baseline; ▲=increase from baseline.

Figure 4 Impact of temporal changes in serum albumin levels on subsequent mortality risk. MICS, malnutrition–inflammation complex syndrome. Reproduced from Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, et al. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrology Dialysis Transplant. 2020;20(9):1880–1888, by permission of Oxford University Press.⁷⁴

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