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Lower serum albumin level is associated with higher fractional excretion of creatinine

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Abstract

Background

Creatinine clearance (Ccr) overestimates glomerular filtration rate (GFR) due to the tubular secretion of creatinine. It is known that fractional excretion of creatinine (FE-Cr) increases with decreasing GFR. Association of serum albumin level with the tubular secretion of creatinine was also reported previously. Alteration of FE-Cr may affect the performance of GFR estimating equations based on serum creatinine. Therefore, we analyzed the factors influencing FE-Cr and compared the performance of GFR equations in subjects stratified by serum albumin levels.

Methods

Seven hundred and fifty-seven Japanese subjects were included. GFR was measured by inulin renal clearance. GFR and Ccr were measured simultaneously. FE-Cr was calculated as the ratio of Ccr to GFR. Multivariate analysis was performed to evaluate the factors influencing FE-Cr. Age, gender, GFR, body mass index (BMI), body weight, height and serum albumin level were analyzed as the parameters. Estimated GFR was calculated by Japanese GFR equations based on serum creatinine (Eq-cr), serum cystatin C (Eq-cys) and 5 variables including serum albumin (Eq-5var).

Results

FE-Cr in subjects with serum albumin <3.0, 3.0–3.9 and ≥4.0 g/dl were 1.63 ± 0.48, 1.53 ± 0.55, and 1.40 ± 0.36, respectively. FE-Cr in subjects with serum albumin <3.0 or 3.0–3.9 g/dl were significantly higher than the value in subjects with serum albumin ≥4.0 g/dl. Multivariate analysis showed that GFR (p < 0.0001) and serum albumin level (p = 0.004) were independent parameters affecting FE-Cr. Biases of Eq-cr, Eq-cys and Eq-5var in subjects with serum albumin <3.0 g/dl were −9.5 ± 17.5, −0.7 ± 17.1 and −0.6 ± 14.8 ml/min/1.73 m2, respectively. Eq-cr significantly overestimated GFR compared with Eq-cys or Eq-5var. Biases in subjects with serum albumin ≥4.0 g/dl were 6.4 ± 18.8, 2.0 ± 18.1 and 3.0 ± 18.3 ml/min/1.73 m2, respectively. Eq-cr significantly underestimated GFR compared with Eq-cys or Eq-5var.

Conclusion

GFR and serum albumin level were independent parameters affecting FE-Cr. Alteration of FE-Cr according to the serum albumin levels may be one of the reasons of the bias of GFR equation based on serum creatinine.

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Acknowledgments

This study was supported in part by the grant from the Japanese Society of Nephrology and Health and Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare, Japan.

Conflict of interest

All the authors have declared no conflict of interest.

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Authors and Affiliations

  1. Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan

    Masaru Horio

  2. Nakayamadera Imai Clinic, Takarazuka, Japan

    Enyu Imai

  3. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshinari Yasuda

  4. Department of CKD Initiatives, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshinari Yasuda & Seiichi Matsuo

  5. Third Department of Medicine, Fukushima Medical University, Fukushima, Japan

    Tsuyoshi Watanabe

Authors
  1. Masaru Horio
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  2. Enyu Imai
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  3. Yoshinari Yasuda
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  4. Tsuyoshi Watanabe
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  5. Seiichi Matsuo
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Corresponding author

Correspondence to Masaru Horio.

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Horio, M., Imai, E., Yasuda, Y. et al. Lower serum albumin level is associated with higher fractional excretion of creatinine. Clin Exp Nephrol 18, 469–474 (2014). https://doi.org/10.1007/s10157-013-0841-5

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  • DOI: https://doi.org/10.1007/s10157-013-0841-5

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