The root cause analysis of hypoalbuminemia in patients on peritoneal dialysis: a single center study

Purpose: Hypoalbuminemia is a common problem in patients on peritoneal dialysis (PD). It can lead to significant morbidity and mortality. Protein loss into PD effluent is a reason that PD patients require high protein. This study aim to analysis the prevalence and perform root cause analysis (RCA) of hypoalbuminemia in patients on PD.

Method: Patients on PD with serum albumin (Salb) less than 3.5 g/dL during September 2017 to October 2018 at the HRH Princess Maha Chakri Sirindhorn Medical Center were evaluated for amount of calorie, and protein intake. The causes of hypoalbuminemia were classified into lack of knowledge, boring or depression, inability to access food or economic problem, current sickness and related to PD.

Result: There were 181 from 209 (86.6%) cases having Salb less than 3.5 g/dL. They were 83(45.9%) male and 83 (45.9%) patients having previous diabetes. The causes from inadequate calorie intake, inadequate protein intake, inadequate calorie and protein intake were 9 (4.9%), 72 (39.8%), and 64 (35.4%) cases, respectively. Most of patients were from lack of knowledge (106; 58.6%). Patients with hypoalbuminemia from boring or depression, sickness, related to PD, and inability to access food were 27 (14.9%), 8 (4.4%), 6 (3.3%), and 3 (1.7%) cases, respectively. There were 31 (17.1%) cases unable to identify the reason of hypoalbuminemia.

Conclusion: The prevalence of hypoalbuminemia was high. Most of the cause of hypoalbuminemia was from the lack of knowledge. This finding will be useful to set up education program to patients to improve knowledge of patients.