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C Haller - One of the best experts on this subject based on the ideXlab platform.

  • Hypoalbuminemia in renal failure: pathogenesis and therapeutic considerations.
    Kidney & blood pressure research, 2005
    Co-Authors: C Haller
    Abstract:

    Hypoalbuminemia is common in patients with end-stage renal disease (ESRD). It is caused by a combination of a reduced synthesis and an increased degradation of albumin. The altered albumin homeostasis in ESRD patients is caused by a systemic inflammatory state which correlates closely with mortality. Hypoalbuminemia is a strong predictor of an adverse prognosis, but it is not a pathogenic factor in itself. In critically ill patients in intensive care units, the intravenous administration of human serum albumin generally does not improve prognosis. In contrast, in hypoalbuminemic dialysis patients with volume overload and a reduced effective arterial volume the administration of albumin is based on the pathophysiological concept of increasing intravascular oncotic pressure to transfer extravascular fluid into the intravascular compartment for ultrafiltration in order to mobilize edema fluid.

Lionel N Metz - One of the best experts on this subject based on the ideXlab platform.

  • Hypoalbuminemia is associated with septic revisions after primary surgery and postoperative infection after revision surgery
    Spine, 2017
    Co-Authors: Krishn Khanna, David C Sing, Erik J Geiger, Lionel N Metz
    Abstract:

    STUDY DESIGN Retrospective database review. OBJECTIVE To determine (1) the relationship between Hypoalbuminemia and body mass index (BMI); (2) the association between malnutrition and revision spine surgery for septic reasons; and (3) the association between malnutrition and infection after aseptic revision spine surgery. SUMMARY OF BACKGROUND DATA Although malnutrition has been suggested to increase the risk of infection after spine surgery, evidence supporting this hypothesis is conflicting. METHODS Patients undergoing revision spine surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2014. Hypoalbuminemia (albumin < 3.5 g/dL) was used as a surrogate marker of malnutrition. Multivariate analysis was used to assess the association of Hypoalbuminemia with septic versus aseptic revision spine surgery. The association between Hypoalbuminemia and deep infection postoperatively within 30 days of aseptic revision surgeries was also assessed. RESULTS A total of 3136 patients who underwent revision spine surgery were identified; 2922 (93.2%) underwent surgery for aseptic reasons, and 214 (6.8%) for septic reasons. Hypoalbuminemia was present in all BMI groups including obese patients, though it was highest in underweight patients (22.4%). Patients who underwent surgery for septic reasons had a higher rate of Hypoalbuminemia than those undergoing surgery for aseptic reasons (49.1% vs. 8.5%, P < 0.001) with nine times the odds of having Hypoalbuminemia (adjusted odds ratio, OR = 9.17, P < 0.001). Of the 2922 patients undergoing revision spine surgery for aseptic reasons, Hypoalbuminemia was independently associated with acute deep infection within 30 days of surgery (adjusted OR = 2.85, P = 0.019). CONCLUSION Malnutrition is more common in revision spine surgery for septic reasons when compared with aseptic revision surgery. Acute postoperative infection following aseptic revision surgery is also more common in patients with malnutrition. Further study, in the form of prospective trials, will help to increase our understanding of the effects of malnutrition in spine surgery. LEVEL OF EVIDENCE 3.

Hans W. Sollinger - One of the best experts on this subject based on the ideXlab platform.

  • The impact of Hypoalbuminemia in kidney-pancreas transplant recipients.
    Transplantation, 1999
    Co-Authors: Bryan N. Becker, Yolanda T. Becker, Dennis M. Heisey, G. Leverson, Bradley H. Collins, Jon S. Odorico, Angelo D'alessandro, Stuart J. Knechtle, John D. Pirsch, Hans W. Sollinger
    Abstract:

    BACKGROUND Hypoalbuminemia is associated with poorer outcomes in renal transplantation. Diabetes can compound Hypoalbuminemia's detrimental effects. Kidney-pancreas transplantation alters the diabetic milieu; yet, some patients continue to be hypoalbuminemic. METHODS We retrospectively analyzed 232 patients who underwent simultaneous kidney-pancreas transplantation (SPK) between 1993 and 1997 to determine the incidence and clinical correlates of Hypoalbuminemia in SPK recipients. Post-SPK Hypoalbuminemia was defined as a serum albumin level < or =3.5 g/dl. Univariate analyses were performed to determine whether post-SPK Hypoalbuminemia was associated with pre-SPK variables. The effect of albumin level and Hypoalbuminemia on the risk of post-SPK events (cardiac events, cytomegalovirus [CMV] infection, rejection, readmission, kidney and pancreas graft failure, and death) was examined with a Cox proportional hazards model. RESULTS The study population consisted of 149 men and 83 women. Average follow-up was 2.0+/-1.3 years. Hypoalbuminemia (serum albumin level < or =3.5 g/dL) was most common early after SPK (3 months: 44% of evaluable patients were hypoalbuminemic; 12 months: 15.3%; 36 months: 8.3%). Acute rejection episodes and readmission were the most common adverse events after SPK transplantation. There were 24 episodes of renal allograft loss and only 5 cardiac events. Ten SPK recipients died during the study time period. SPK-related Hypoalbuminemia was associated with an increased risk for CMV infection (risk ratio [RR] 2.5; P

Massimo Bolognesi - One of the best experts on this subject based on the ideXlab platform.

  • Hypoalbuminemia
    Internal and Emergency Medicine, 2012
    Co-Authors: Angelo Gatta, Alberto Verardo, Massimo Bolognesi
    Abstract:

    Hypoalbuminemia is frequently observed in hospitalized patients and it can be associated with several different diseases, including cirrhosis, malnutrition, nephrotic syndrome and sepsis. Regardless of its cause, Hypoalbuminemia has a strong predictive value on mortality and morbidity. Over the years, the rationale for the use of albumin has been extensively debated and the indications for human serum albumin supplementation have changed. As the knowledge of the pathophysiological mechanisms of the pertinent diseases has increased, the indications for intravenous albumin supplementation have progressively decreased. The purpose of this brief article is to review the causes of Hypoalbuminemia and the current indications for intravenous administration of albumin. Based on the available data and considering the costs, albumin supplementation should be limited to well-defined clinical scenarios and to include patients with cirrhosis and spontaneous bacterial peritonitis, patients with cirrhosis undergoing large volume paracentesis, the treatment of type 1 hepatorenal syndrome, fluid resuscitation of patients with sepsis, and therapeutic plasmapheresis with exchange of large volumes of plasma. While albumin supplementation is accepted also in other clinical situations such as burns, nephrotic syndrome, hemorrhagic shock and prevention of hepatorenal syndrome, within these contexts it does not represent a first-choice treatment nor is its use supported by widely accepted guidelines.

Alan Shenkin - One of the best experts on this subject based on the ideXlab platform.

  • Hypoalbuminemia: Pathogenesis and Clinical Significance.
    JPEN. Journal of parenteral and enteral nutrition, 2018
    Co-Authors: Peter B. Soeters, Robert R. Wolfe, Alan Shenkin
    Abstract:

    Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half-life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to Hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin "from the shelf" is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.