How can albumin levels be increased?

How to Increase Albumin Levels

To increase albumin levels, ensure adequate protein intake of 1.2 g/kg body weight per day with at least 50% from high biological value sources, correct underlying inflammation or catabolic illness, and maintain proper hydration status. 1

Understanding Albumin

Albumin is a key protein produced exclusively by the liver that:

• Maintains plasma colloidal osmotic pressure
• Transports drugs and nutrients
• Has antioxidant and anti-inflammatory properties
• Serves as a strong predictor of morbidity and mortality

Dietary Interventions

Protein Intake

• Target protein intake: 1.2 g/kg body weight/day 1
  • At least 50% should be high biological value protein (meat, eggs, dairy)
  • For dialysis patients, protein needs may be higher (1.2-1.3 g/kg/day) 1

Protein Supplements

• Whey protein supplementation has been shown to significantly increase serum albumin levels in hypoalbuminemic patients 2
  • Supplementation at 25% of daily protein requirements improved albumin levels and lean tissue mass
  • Well-tolerated and effective intervention

Medical Interventions

Treat Underlying Conditions

• Address inflammation: Inflammation is a major cause of hypoalbuminemia, limiting the specificity of albumin as a nutritional marker 1
• Correct acidemia: Maintain serum bicarbonate at or above 22 mmol/L 1
  • Acidemia increases protein degradation and decreases albumin synthesis
  • Correction can increase serum albumin levels

Vitamin D Supplementation

• Alfacalcidol supplementation (0.5 μg daily) has been shown to increase protein intake and serum albumin concentration in hemodialysis patients with hypoalbuminemia 3
  • Works by suppressing tumor necrosis factor activity
  • Increases normalized protein catabolic rate

Monitoring Approach

Regular Assessment

• Monitor serum albumin levels at least every 4 months 1
• Serial measurements are more valuable than single readings 4
• Evaluate trends: A decreasing albumin level (e.g., 0.1 g/dL/month) may indicate higher risk than a stable low level 1

Comprehensive Evaluation

• Assess hydration status: Dehydration can artificially elevate albumin levels through hemoconcentration 4
• Check for comorbid conditions: Age, diabetes, and peritoneal solute transport are major predictors of serum albumin 1

Special Considerations

For Dialysis Patients

• Maintain adequate dialysis clearance: Ensure Kt/Vurea and creatinine clearance at or above recommended levels 1
• Target normalized PNA (nPNA) of ≥0.9 g/kg/day 1
• Monitor and prevent protein losses: Dialysis procedures can result in loss of amino acids and proteins 1

For Patients with Inflammation

• Identify and treat sources of inflammation: Measure inflammatory markers (C-reactive protein, alpha-1 acid glycoprotein) to identify inflammation in patients with low albumin 1
• Prioritize treatment of catabolic illness: This can improve albumin synthesis even when dietary protein intake is adequate 1

Common Pitfalls to Avoid

• Don't focus solely on albumin levels: Albumin should be evaluated in context of overall clinical status 1
• Don't ignore hydration status: Dehydration can falsely elevate albumin levels 4
• Don't assume hypoalbuminemia is purely nutritional: Inflammation, comorbidities, and other factors significantly impact albumin levels 1
• Don't rely on albumin infusions as a long-term solution: Addressing the underlying cause of hypoalbuminemia is more important than temporary correction 5

By following these recommendations with particular attention to adequate protein intake, treating underlying inflammation, and correcting metabolic abnormalities, albumin levels can be effectively increased in most patients.