albumin - publications

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1. Nephrol Dial Transplant. 2012 Apr 19. [Epub ahead of print]

Hypoalbuminaemia, systemic albumin leak and endothelial dysfunction in peritoneal
dialysis patients.

Yu Z, Tan BK, Dainty S, Mattey DL, Davies SJ.

1Department of Nephrology, University Hospital of North Staffordshire, Stoke on
Trent, UK.

BACKGROUND: Inflammation, hypoalbuminaemia and peritoneal protein clearance are
important predictors of survival in patients treated with peritoneal dialysis
(PD). We hypothesized that the common link is abnormal endothelial barrier
function. To test this, we explored associations between hypoalbuminaemia,
systemic albumin leak and soluble markers of systemic inflammation and
endothelial injury.METHODS: This was a cross-sectional study of 41 prevalent PD
patients. Endothelial barrier function was measured as transcapillary escape rate
of (125)I albumin [transcapillary escape rate of albumin (TER(alb))]. Seventeen
plasma biomarkers including pro-inflammatory cytokines, endothelial biomarkers
and metalloproteinases were measured. Hierarchical clustering analysis (HCA) and
principal component analysis (PCA) were used to explore the hypothesis.RESULTS:
The mean TER(alb) was 13.7 ± 8.9 (%/h), higher than in non-uraemic subjects 8.22
± 5.8 (%/h). Three patient clusters were defined from HCA according to their
biomarker patterns. Cluster 1 was characterized by inflammation,
hypoalbuminaemia, overhydration and intermediate TER(alb). Cluster 2 was
non-inflamed, preserved muscle mass and more normal TER(alb). Cluster 3 had
highest TER(alb), platelet activation, preserved plasma albumin and intermediate
high-sensitivity C-reactive protein levels. Two principal components (PCs) were
identified from the biomarker matrix, PC1, indicating platelet activation and
PC2, pro-inflammatory. TER(alb) was positively related to PC1 but not PC2.
Diabetes and ischaemic heart disease were associated with PC1 and PC2,
respectively.CONCLUSIONS: This exploratory analysis indicates that endothelial
barrier function is decreased in PD patients and is associated with diabetic
status and markers of platelet activation more than inflammation. In contrast,
hypoalbuminaemia is associated more with inflammation and atherosclerotic disease
indicating a more complex relationship between systemic endothelial barrier
function, inflammation and hypoalbuminaemia which requires further validation.

PMID: 22516624 [PubMed - as supplied by publisher]