Ernährungsmarker – Warum sollten wir Präalbumin bei Dialysepatienten messen?

Präalbumin (Transthyretin) ist ein valider und hilfreicher Parameter für die Evaluation einer Protein-Energie-Mangelernährung (PEM) in der klinischen Praxis, insbesondere auch bei Dialysepatienten. Im Folgenden wird auf die diagnostische und prädiktive Bedeutung erniedrigter Präalbumin-Serum-Spiegel (< 30 mg/dl) sowie auf einen möglichen ernährungstherapierelevan-ten Präalbuminanstieg (> 3 mg/dl über 3 Monate) eingegangen. Präalbumin sollte daher als gängiger Laborroutineparameter bei Dialysepatienten gesehen und dementsprechend auch gemessen werden.

Prealbumin (transthyretin) is a valid and useful parameter for the evaluation of protein-energy malnutrition (PEM) in clinical practice, especially in dialysis patients. The diagnostic and predictive importance of decreased prealbumin serum levels (< 30 mg/dl) will be explained as well as possible relevant elevation of prealbumin concentration (> 3 mg/dl over 3 months) by nutritional supplements. Prealbumin should be seen as a routine laboratory parameter in dialysis patients and therefore also measured.

Key words

mortality - nutritional status - prealbumin - protein-energy malnutrition

• Literatur

• 1 Chertow GM, Goldstein-Fuchs DJ, Lazarus JM, Kaysen GA. Prealbumin, mortality, and cause-specific hospitalization in hemodialysis patients. Kidney Int 2005; 68: 2794-2800
• 2 Fiedler R, Jehle PM, Osten B et al. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrol Dial Transplant 2009; 24: 3812-3817
• 3 Kalantar-Zadeh K, Cano NJ, Budde K et al. Diets and enteral supplements for improving outcomes in chronic kidney disease. Nat Rev Nephrol 2011; 7: 369-384
• 4 Pupim LB, Caglar K, Hakim RM et al. Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int 2004; 66: 2054-2060
• 5 Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000; 35
• 6 Cano N, Fiaccadori E, Tesinsky P et al. ESPEN guidelines on enteral nutrition: Adult renal failure. Clin Nutr 2006; 25: 295-310
• 7 Dukkipati R, Kopple JD. Causes and prevention of protein-energy wasting in chronic kidney failure. Semin Nephrol 2009; 29: 39-49
• 8 Hakim RM, Levin N. Malnutrition in hemodialysis patients. Am J Kidney Dis 1993; 21: 125-137
• 9 Cano NJM, Fouque D, Roth H et al. French Study Group for Nutrition in Dialysis. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 2007; 18: 2583-2591
• 10 Rambod M, Kovesdy CP, Bross R et al. Association of serum prealbumin and its changes over time with clinical outcomes and survival in patients receiving hemodialysis. Am J Clin Nutr 2008; 88: 1485-1494
• 11 Friedman AN, Fadem SZ. Reassessment of albumin as a nutritional marker in kidney disease. J Am Soc Nephrol 2010; 21: 223-230
• 12 Sreedhara R, Avram MM, Blanco M et al. Prealbumin is the best nutritional predictor of survival in hemodialysis and peritoneal dialysis. Am J Kidney Dis 1996; 28: 937-942
• 13 Devoto G, Gallo F, Marchello C et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem 2006; 52: 2281-2285
• 14 Spiekerman AM. Proteins used in nutritional assessment. Clin Lab Med 1993; 13: 353-369
• 15 Myron JohnsonA, Merlini G, Sheldon J, Ichihara K. Scientific Division Committee on Plasma Proteins (C-PP), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clin Chem Lab Med 2007; 45: 419-426
• 16 Ingenbleek Y, Young V. Transthyretin (prealbumin) in health and disease: nutritional implications. Ann Rev Nutr 1994; 14: 495-533
• 17 Bernstein LH, Pleban W. Prealbumin in nutrition evaluation. Nutrition 1996; 12: 255-259
• 18 Bernstein LH, Leukhardt-Fairfield CJ, Pleban W, Rudolph R. Usefulness of data on albumin and prealbumin concentrations in determining effectiveness of nutritional support. Clin Chem 1989; 35: 271-274
• 19 Vehe KL, Brown RO, Moore LW et al. The efficacy of nutrition support in infected patients with chronic renal failure. Pharmacotherapy 1991; 11: 303-307
• 20 Caglar K, Fedje L, Dimmitt R et al. Therapeutic effects of oral nutritional supplementation during hemodialysis. Kidney Int 2002; 62: 1054-1059