Relation of Serum Albumin Level and C- reactive Protein to Hypotensive Episodes during Hemodialysis Sessions

Background: Intradialytic hypotension (IDH) remains the most common complication of hemodialysis (HD) with potentially devastating consequences despite the technological advances regarding the hemodialysis techniques of the last decades. The increasing number of advanced-age patients, diabetics and patients with cardiovascular comorbidities undergoing hemodialysis emphasizes the need on implementation of new IDH avoidance tactics. Aim of the Work: Our work aimed to evaluate serum albumin (Alb) level and C-reactive protein level in hemodialysis patients and their correlation with dialysis-induced hypotension (DIH).
Patients and Methods: This prospective study was conducted based on data collected from HD patients treated at Aswan University Hospital, dialysis unit, in a period from 1/1/2017 to 30/5/2017. It included 40 chronic HD patients with no history of endocrine tumors, diabetes mellitus, liver failure, heart failure, or unstable coronary artery disease. Patients with hemoglobin less than 9 mg/dL, feverish patients, and patients with any source of apparent infection were excluded. The age of the patients ranged from over 18 to less than 75 years. Results: : the mean value of serum albumin level in group (A) was (2.97 ± 0.71)  with  the highest serum albumin was 4.4 and the lowest serum albumin was 2.1, while in Group (B) the mean value of serum albumin level was (4.53 ± 0.74)  with  the highest serum albumin was 5.5 and the lowest serum albumin was 2.8. There was a significant decrease in serum albumin level in patients in group (A) who had developed  hypotensive episodes during hemodialysis ( P value < 0.001), in group (A) also there were 18 patients had positive C-reactive protein (90 %) and 2 patients had negative C-reactive protein (10 %) with a mean value (15.67 ± 13.27), while in group B : there were 2 patients had positive  C-reactive protein level  (10 %)  and 18 patients had negative C-reactive protein level  ( 90 %) with a mean value (2.07 ± 1.48) , So, there was a significant  increase in  C-reactive protein level in patients in group (A) who had developed hypotensive episodes during dialysis ( P value < 0.001). Conclusion: Serum Alb. levels and high levels of CRP may predict an increased risk of DIH in regular HD patients and this was the main issue for our study, however we also found that there were some other biochemical markers, which can come inbetween with our two main markers, which confirm our results. Recommendations: Further studies on a larger scale of patients are needed to confirm these results.