Int J Med Sci 2019; 16(12):1583-1592. doi:10.7150/ijms.39158

Research Paper

Hypoalbuminemia differently affects the serum bone turnover markers in hemodialysis patients

Cai Mei Zheng1,3, Chia Chao Wu4, Chien Lin Lu1,5, Yi Chou Hou1,6, Mai Szu Wu1,3, Yung Ho Hsu1,3, Remy Chen7, Tian Jong Chang8,9, Jia Fwu Shyu1,10, Yuh Feng Lin1,3✉*, Kuo Cheng Lu1,5✉*

1. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
2. Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11103, Taiwan
3. Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
4. Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
5. Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
6. Division of Nephrology, Department of Medicine, Cardinal-Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City 23155, Taiwan
7. Chief, Kidney Dialysis Center, Hasuda Hospital, Negane, Hasuda City, Saitama, 3490131, Japan
8. Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan
9. Performance Appraisal Section, Secretary Office, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
10. Department of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan
*These authors contributed equally to this work.

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Citation:
Zheng CM, Wu CC, Lu CL, Hou YC, Wu MS, Hsu YH, Chen R, Chang TJ, Shyu JF, Lin YF, Lu KC. Hypoalbuminemia differently affects the serum bone turnover markers in hemodialysis patients. Int J Med Sci 2019; 16(12):1583-1592. doi:10.7150/ijms.39158. Available from http://www.medsci.org/v16p1583.htm

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Abstract

Renal osteodystrophy (ROD) represents bone disorders related to chronic kidney disease (CKD) and several bone biomarkers are used clinically to predict ROD in CKD and hemodialysis (HD) patients. Serum albumin associates with inflammation other than nutritional status in these patients. Chronic inflammation is proved to relate with bone loss, however, the influence of hypoalbuminemia on bone biomarkers is still unclear. In this study, we evaluated the pattern of bone biomarker changes and further studied the influence of hypoalbuminemia on these biomarkers. A total of 300 maintenance HD patients were evaluated and 223 HD patients were included in the study. The patients were grouped according to serum parathyroid hormone (PTH) levels (PTH ≤150 pg/mL, PTH 150-300 pg/mL, PTH 300-600 pg/mL and PTH >600 pg/mL). Bone biomarkers and inflammatory markers were measured and their relation with PTH levels was determined. Significantly increased interleukin-6 (IL-6) and lower albumin levels were noted among PTH>600 pg/mL group. Bone turnover markers were significantly higher in PTH >600 pg/mL group (p< 0.05). Hypoalbuminemia significantly increased the fibroblast growth factor-23 (FGF-23) and procollagen type 1N-terminal propeptide (P1NP) in PTH ≤150 pg/mL, PTH 150-300 pg/mL, PTH 300-600 pg/mL groups, whereas no such relation was noted among PTH> 600 ng/dL group. In conclusion, hypoalbuminemia represents a chronic inflammation which differently relates to bone turnover markers according to serum PTH levels in SHPT patients. Thus, serum albumin measurement should be considered in determining bone disorders among these patients.

Keywords: renal osteodystrophy, hypoalbuminemia, bone turnover markers, inflammation, hemodialysis patients