Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure.

Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure. Background Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown. Methods In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients ( N = 6), patients on peritoneal dialysis ( N = 7) and control subjects ( N = 8) using L-[1- 13 C]-valine. Results Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects ( P P P P P r 2 = 0.665, P N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance. Conclusion Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.