Protein Loss During Dialysis

[Rerun]

I've always thought that we lose protein during dialysis.  Like some of it dialyzes out.  My new Nephrologist said we don't or shouldn't lose any protein during dialysis.....    I've done some reading on it but thought I'd ask you guys.

I thought that is why we are on a high protein diet...

[jeannea]

I thought it was because with our kidneys not working we don't produce enough albumin. Apparently, you need lots of fluid for your body to have albumin. We keep our bodies dehydrated.

[obsidianom]

J Ren Nutr. 2002 Oct;12(4):209-12.

The relationship between serum albumin and hydration status in hemodialysis patients.

Jones CH1, Akbani H, Croft DC, Worth DP.


Author information
Abstract
OBJECTIVE:

A decreased serum albumin level predicts poor survival in end-stage renal failure. Hypoalbuminemia is multifactorial and related to poor nutrition, inflammation, and comorbid disease. Overhydration is also common in renal replacement therapy patients, and hemodilution may also contribute to a low serum albumin level.

DESIGN:

Crosssectional observational study.

SETTING:

Outpatient hemodialysis unit of a district general hospital.

SUBJECTS:

We investigated the relationship of serum albumin to C-reactive protein (CRP) and hydration state in 49 unselected hemodialysis patients (28 men).

METHODS:

Patients were assessed predialysis and postdialysis at their clinical dry weight. Extracellular fluid volume (Vecf) and total body water (Vtbw) were estimated by whole-body bioelectric impedance. Vecf was expressed as a percentage of Vtbw (Vecf%Vtbw). Predialysis CRP, predialysis and postdialysis serum albumin, and body weight were measured. Normalized protein catabolic rate (nPCR) and KT/V urea were calculated.

RESULTS:

Predialysis and postdialysis serum albumin levels were 36.9 g/L (95% CI, 35.7 and 38.1) and 41.4 g/L (95% CI, 39.7 and 43.3), respectively (P <.0001). Mean weight change was 2.0 +/- 1.2 kg. Predialysis and postdialysis serum albumin levels were negatively correlated with CRP (before: r = -0.393, P <.005; after: r = -0.445, P =.001) and positively with nPCR (before: r = 0.336, P =.018; after: r = 0.353, P =.013). Predialysis serum albumin level correlated with predialysis Vecf%Vtbw (r = -0.384, P =.006) and postdialysis serum albumin level with postdialysis Vecf%Vtbw (r = -0.654, P <.0001). In multivariate analysis, predialysis albumin was dependent on nPCR (P =.04), CRP (P <.0001), and predialysis Vecf%Vtbw (P =.002), and postdialysis albumin was dependent on nPCR (P =.01), CRP (P =.002), and postdialysis Vecf%Vtbw (both P <.0001). The increase in albumin was strongly correlated with both change in actual weight (r = -0.651, P <.0001) and change in Vecf%Vtbw (r = -0.684, P <.0001).

CONCLUSION:

In unselected hemodialysis patients, serum albumin level is dependent on nPCR, CRP, and extracellular fluid volume. This relationship persists after dialysis, suggesting that many patients remain fluid overloaded at their postdialysis dry weight.

Copyright 2002 by the National Kidney Foundation, Inc.

[obsidianom]

It is really more chronic inflammation that causes hypoalbuminemia in dialysis .
CRP is a marker of inflammation
BACKGROUND:

Cross-sectional studies have shown an inverse correlation between serum C-reactive protein (CRP) and serum albumin concentration in hemodialysis patients

Abstract


PURPOSE:

Serum albumin is one of the strongest mortality predictors in maintenance hemodialysis (MHD) patients. Yet, the degree to which serum albumin represents dietary protein intake or an inflammatory state, among others, is not clear. We hypothesize that these inadequate protein intake and inflammation contribute somewhat equally to hypoalbuminemia.

[Rerun]

So fluid in the body dilutes the blood test for albumin?  They take the monthly blood test after a weekend before dialysis. 

To me that is a scam.  They should take the blood post dialysis.

So, do we lose any protein during dialysis?

[obsidianom]

So fluid in the body dilutes the blood test for albumin?  They take the monthly blood test after a weekend before dialysis. 

To me that is a scam.  They should take the blood post dialysis.

So, do we lose any protein during dialysis?

Fluid has little to do with hypoalbuminemia. It is all about nutrition and inflammation which is chronic in dialysis patients.  Yes some protein is probably lost during dialysis but it is not the major issue.

[obsidianom]

There is some albumin loss from the dialysis membrane. Different with different types.

Abstract
The elimination of substances between 10 and 50 kDa by conventional high-flux membranes is not satisfactory. We investigated in vivo the elimination of middle-sized uremic solutes by conventional polyflux (PF) and modified high-cut-off (HCO) membranes. All 12 patients underwent four treatments, two with the HCO dialyzer and two with the PF dialyzer, each in either a haemodialysis (HD) or haemodiafiltration (HDF) mode. The reduction ratio of urea, creatinine, β2-microglobulin (β2M), leptin, soluble TNF-RI, complement factor D, IL-6, sIL-6 receptor, advanced glycation end-products (AGEs) and albumin was determined. In addition, the amount removed was determined in the dialysate for β2M, complement factor D, AGEs and albumin. Treatment with HCO removed β2M, sTNF-RI, factor D, and high molecular AGE significantly better than conventional high-flux membranes. The albumin loss was higher when using HCO membranes. HCO membranes are a promising approach to improve removal of uremic toxins not affected by conventional high-flux membranes.

[PrimeTimer]

The conversation of protein (and inflammation) has me thinking about Omega-3 supplements and/or fish oil and it's benefits in reducing inflammation and in turn, helping with the protein level. Am also wondering if fish oil can help with dehydration.

[deniferfer]

I did a lot of studying on protein and dialysis and actually found out that yes we do lose some protein during dialysis. That we actually should have about 3oz a half hour before and after treatment.

[talker]

(Part of the article)

Management of Protein and Energy Intake in Dialysis Patients

MARSHA WOLFSON
 

+
 Author Affiliations
 Renal Division, Baxter HealthCare Corporation, McGaw Park, Illinois. 
Correspondence to Dr. Marsha Wolfson, Renal Division Research MPR-D1, Baxter Healthcare Corporation, 1620 Waukegan Road, McGaw Park, IL 60085-6730. Phone: 847-473-6342; Fax: 847-473-6902; E-mail: wolfsonm@baxter.com
Received for publication June 30, 1999.
Accepted for publication July 29, 1999.


Amino acids are lost into dialysate (, and, with high flux dialyzers, protein losses are also increased (9). Losses of vitamins into dialysate also occurs (10). Symptoms of uremia include anorexia, nausea, and vomiting, and these symptoms are not always well controlled in maintenance dialysis patients, leading to reduced dietary protein and energy intake. Falkenhagen and coworkers demonstrated that maintenance hemodialysis patients who self-selected their diets were in danger of developing protein-calorie malnutrition (11). Patients with ESRD treated with either hemodialysis or peritoneal dialysis demonstrate altered patterns of food intake (12). The cause of reduced appetite is not entirely understood, but elevated serum leptin or other factors, which suppress appetite, may be involved. All of these abnormalities can result in the development of malnutrition.
For an understanding of the protein requirements for people treated with maintenance dialysis, one can look at those studies carried out in metabolic units to determine the level of dietary protein intake that will result in neutral or positive nitrogen balance. Studies by Blumenkrantz et al. and Bergstrom et al. in CAPD patients demonstrate that nitrogen balance is negative with diets providing less than 1.2 g protein/kg body wt per d (24, 25). This requirement is higher than that recommended for healthy subjects, which is about 0.8 g/kg per d. In hemodialysis patients, there are no randomized, prospective trials that examine dietary protein intake and outcomes. However, several studies carried out by measurement of nitrogen balance demonstrate that approximately 1.2 g/kg per d of high biologic value protein is associated with positive nitrogen balance (4, 26, 27).

These higher protein requirements may be due to losses of protein and amino acids into dialysate, or the catabolic effect of the hemodialysis procedure. Several studies report losses of approximately 1 to 2 g of protein into dialysate with conventional hemodialyzers, but may be higher with high-flux dialyzers (9). Losses of amino acids into hemodialysate average 6 to 12 g per treatment (. Losses of proteins into dialysate are higher with peritoneal dialysis compared to hemodialysis, and are reported to be approximately 5 to 15 g/d, and protein losses increase with episodes of peritonitis (28). These data lead to the recommendation that dietary protein intake for patients treated with peritoneal dialysis should be approximately 1.3 g protein/kg body wt per d, to be certain that all patients receive adequate protein intake (24,25,26).

http://jasn.asnjournals.org/content/10/10/2244.full

[obsidianom]

The conversation of protein (and inflammation) has me thinking about Omega-3 supplements and/or fish oil and it's benefits in reducing inflammation and in turn, helping with the protein level. Am also wondering if fish oil can help with dehydration.

I give my wife 3 fish oil caps per day every day and add 4 scoops Beneprotein . Her albumin is running 4.1 now. So it is working.

[Rerun]

The metabolic process of dialysis seems to be the culprit of losing protein.  I have heard that dialysis is like running a marathon 3 times a week.  So, we lose a little protein during hemodialysis but that is not the main loss factor.

I feel like the rug has been pulled out from under me as I KNOW I was told that is why we have to be put on a high protein diet was loss of protein during dialysis.  I've TOLD people that.

  

They have this protein solution at dialysis but only those with 3.5 or lower albumin get the little cap-full of the solution.  They let me "taste" the grape last night.  I wish I could just take that and not have to gag down any more eggs!

Thanks for all your research everyone!

  

[obsidianom]

See if you can get BENEPROTEIN cans. I give my wife 4 scoops per day (it is whey based) and her albumin is way up from 3.6 to 4.1 now. It really works . She is dialyzed 5 times per week for 3.5 hours so she really needs it.

[jeannea]

Does any of that stuff taste ok or is it all icky? The protein supplements.

[Michael Murphy]

In my Hemo center the patients with low albumin levels are given some form of Protein Ice Cream.  Every one raves about the Chocolate flavor and Likes the Vanilla, the Strawberry has been said to be vile.  My albumin level is to high to get these treats However the People who need them speak highly of them.

[PrimeTimer]

The conversation of protein (and inflammation) has me thinking about Omega-3 supplements and/or fish oil and it's benefits in reducing inflammation and in turn, helping with the protein level. Am also wondering if fish oil can help with dehydration.

I give my wife 3 fish oil caps per day every day and add 4 scoops Beneprotein . Her albumin is running 4.1 now. So it is working.

In addition to ESRD, my husband has Type II Diabetes. His Endocrinologist was the one who had him on a prescription purified Omega-3 fish oil. He stopped taking it because of a high co-payment at the time. I'd really like him to bring it up with his Neph tho and maybe start taking it again. Right now, he eats those "Pure Protein" sports bars from Walmart but not every day. We don't eat as much meat or eggs as we like/should but his Albumin was at 4.3 last month (Neph set his goal at 4 or higher). 


** For those interested in protein ice cream,
see the Diet and Recipes topic for "Zach's High Protein Chocolite Whey Ice Cream". I really would like to get an ice cream maker and try it.

[Sugarlump]

Maybe this is why I have to eat very soon after dialysis I am always famished.
But excesss fluid definitely affects blood test results (diluting true results)
We have blood tests midweek (first Wed of every month) taken both before and after dialysis
I've noticed my hb always increases after dialysis