Nutritional therapy in hypoalbuminemia patient with chronic kidney disease on hemodialysis

Background: Hypoalbuminemia is common in patients with end-stage renal disease. A combination of a reduced synthesis and an increased degradation of albumin causes it. The altered albumin homeostasis in end stage renal disease patients is caused by a systemic inflammatory state which correlates closely with mortality. Case Presentation: An 81-year-old man was taken to the emergency room with complaints of feeling weak. The patient also complained of shortness of breath, nausea and vomiting. Patient’s weight 60 kg, height 161cm, IMT 23.14kg/m2. The Laboratory showed urea 176 mg/dL, creatinine 6.62 mg/dL, natrium 124 mmol/L and potassium 5,3 mmol/L. The patient’s initial assessment was chronic kidney disease (CKD) stage V. Nutrition therapy is initiated with a liquid diet via NGT and gradually increased with an energy target 1900 kcal/day, protein 55 grams, fat 60 grams and carbohydrates 285 grams. On the third day, the patient transitioned an oral diet with meals soft food, 150kcal nephrisol twice daily and folic acid once daily. Also he was given albumin infusion 25% for 3 days and the diet was supplemented with extra egg whites 3x1 because he has edema in both lower extremities and serum albumin level 2.5g/dL. After 13 days of being treated also supported with good nutritional therapy, the patient was discharged. Clinically improved: edema decreased, the patient is eating well and has no complaints of nausea or vomiting, no longer needed O2 supplementation, hemoglobin increased to 11,3 g/dL, natrium increased to 126 mmol/L and potassium reach normal value, serum albumin increased to 3.0 g/dL after the administration of human albumin serum and extra egg whites, urea 51 mg/dL and creatinine 2.45 mg/dL after hemodialysis. Conclusion: Administration of albumin in hypoalbuminemia dialysis patients with volume overload and a reduced adequate arterial volume is based on the pathophysiological concept of increasing intravascular oncotic pressure to transfer extravascular fluid into the intravascular compartment for ultrafiltration in order to mobilize edema fluid. Oral administration of the egg albumin-based supplement significantly improved serum albumin.