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Hypoalbuminemia is Also a Marker of Fluid Excess Determined by Bioelectrical Impedance Parameters in Dialysis Patients

Abstract:  Hypoalbuminemia may be secondary to volume expansion conditions and an independent risk factor for cardiovascular disease. Bioelectrical impedance analysis (BIA) is an accurate, non‐invasive method to measure body composition, especially the water compartments in humans. The aim of this cross‐sectional study is to evaluate the relationship between serum albumin concentration (SA) and hydration state measured by whole BIA. The study investigated 108 non‐selected patients (73 on hemodialysis, 35 on peritoneal dialysis) with a mean age of 61.4 ± 15.6 years, 42.7% of whom were female. The patients were allotted to groups according to their SA: Group 1, ≤3.5 g/dL; Group 2, 3.6–4.0 g/dL; and Group 3, >4.0 g/dL. The BIA parameters used included: total body water, intracellular water (ICW), extracellular water (ECW), phase angle (PA), body cell mass (BCM), ICW/ECW ratio and ICW/ECW ratio patients/controls (fluid index). Seventy‐five healthy volunteers formed the control group. A strong positive correlation was found between the PA and fluid index (r 2 = 0.993, P < 0.001), as well as between the PA and SA (r = 0.386, P < 0.001), and the ICW/ECW ratio and SA (r = 0.227, P < 0.001). The ECW was negatively correlated with SA (r = −0.330, P < 0.001). Every 0.1 g/dL decrease in SA was associated with a 0.33 L increase in ECW. Group 1 patients had lower reactance (P = 0.006), PA (P < 0.001), BCM (P = 0.012), fluid index (P < 0.001) and ICW/ECW ratio (P = 0.015), and an increased ECW (NS) than groups 2 and 3. We conclude that hypoalbuminemia is also a marker of fluid excess. The SA is associated to the fluid index and the PA allows assessment of the dry weight and its variations in an individualized manner in dialysis patients.