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. 2008 Jan 16;22(1):1–5. doi: 10.1002/jcla.20226

Evaluation of ischemia‐modified albumin in anemia associated to chronic kidney disease

Luiz Carlos Cichota 1,2, Rafael Noal Moresco 1,3, Marta Maria Medeiros Frescura Duarte 4, José Edson Paz da Silva 1,3,✉
PMCID: PMC6649152  PMID: 18200583

Abstract

Chronic kidney disease (CKD) is highly prevalent, with increasing numbers of patients affected by the disease world‐wide, and anemia is a common finding in patients with CKD. Anemia impacts negatively on cardiovascular disease, exercise capacity, and quality of life, resulting in significant mortality and morbidity. The aim of this study was to evaluate the levels of ischemia‐modified albumin and lactate in patients with established anemia associated with CKD and its correlations with hemoglobin levels. Hematocrit, hemoglobin, iron, ferritin, albumin, creatinine, lactate, and ischemia‐modified albumin (IMA) were measured in 17 patients with established anemia associated to CKD and 19 controls by standard methods. The results of hematocrit, hemoglobin, iron, and albumin were lower in the anemia group than in the control group. Ferritin, creatinine, and lactate levels were higher in anemia of the CKD group than the control group. IMA increase in the anemia group (0.8115±0.1304 absorbance units [ABSU]) compared to control (0.4951±0.0393 ABSU). Significant correlations between IMA and lactate, IMA and hemoglobin, IMA and creatinine, and hemoglobin and lactate were observed. IMA and lactate increase during anemia and this elevation could be associated to hypoxia due to low hemoglobin levels. However, our data suggest that lactate is more sensitive to anemia compared to IMA. J. Clin. Lab. Anal. 22:1–5, 2008. © 2008 Wiley‐Liss, Inc.

Keywords: ischemia‐modified albumin, lactate, hemoglobin, anemia, ischemia

REFERENCES

  • 1. El Nahas AM, Bello AK. Chronic kidney disease: the global challenge. Lancet 2005;365:331–340. [DOI] [PubMed] [Google Scholar]
  • 2. Hsu CY. Epidemiology of anemia associated with chronic renal insufficiency. Curr Opin Nephrol Hypertens 2002;11:337–341. [DOI] [PubMed] [Google Scholar]
  • 3. Kerr PG. Renal anaemia: recent developments, innovative approaches and future directions for improved management. Nephrology 2006;11:542–548. [DOI] [PubMed] [Google Scholar]
  • 4. Perlman RL, Finkelstein FO, Liu L, et al. Quality of life in chronic kidney disease (CKD): a cross‐sectional analysis in the Renal Research Institute CKD study. Am J Kidney Dis 2005;45:658–666. [DOI] [PubMed] [Google Scholar]
  • 5. Eschbach JW, Adamson JW. Anemia of end‐stage renal disease (ESRD). Kidney Int 1985;28:1–5. [DOI] [PubMed] [Google Scholar]
  • 6. Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev 2006;20:213–226. [DOI] [PubMed] [Google Scholar]
  • 7. Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol 2006;13:158–165. [DOI] [PubMed] [Google Scholar]
  • 8. Stoltzfus RJ. Iron deficiency: global prevalence and consequences. Food Nutr Bull 2003;24(4 Suppl):S99–S103. [DOI] [PubMed] [Google Scholar]
  • 9. He XM, Carter DC. Atomic structure and chemistry of human serum albumin. Nature 1992;358:209–215. [DOI] [PubMed] [Google Scholar]
  • 10. Cho DK, Choi JO, Kim SH, et al. Ischemia‐modified albumin is a highly sensitive serum marker of transient myocardial ischemia induced by coronary vasospasm. Coron Artery Dis 2007;18:83–87. [DOI] [PubMed] [Google Scholar]
  • 11. Sbarouni E, Georgiadou P, Theodorakis GN, Kremastinos DT. Ischemia‐modified albumin in relation to exercise stress testing. J Am Coll Cardiol 2006;48:2482–2484. [DOI] [PubMed] [Google Scholar]
  • 12. Fagan GJ, Wayment H, Morris DL, Crosby PA. The albumin cobalt binding test: analytical performance of a new automated chemistry assay for the detection of ischemia modified albumin (IMA). Journal of Clinical Ligand Assay 2002;25:178–187. http://www.ingentaconnect.com/content/clas/jcla [Google Scholar]
  • 13. Bar‐Or D, Lau E, Winkler JV. A novel assay for cobalt‐albumin binding and its potential as a marker for myocardial ischemia: a preliminary report. J Emerg Med 2000;19:311–315. [DOI] [PubMed] [Google Scholar]
  • 14. Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of “ischemia modified albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emerg Med J 2004;21:29–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Bhagavan NV, Lai EM, Rios PA, et al. Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction. Clin Chem 2003;49:581–585. [DOI] [PubMed] [Google Scholar]
  • 16. Ceyhan M, Ozalp I, Altay C. High levels of lactate, pyruvate, and alanine in anemic children. Clin Pediatr 1988;27:206–209. [DOI] [PubMed] [Google Scholar]
  • 17. Gidenne S, Ceppa F, Fontan E, Perrier F, Burnat P. Analytical performance of the albumin cobalt binding (ACB®) test on the Cobas MIRA® Plus analyzer. Clin Chem Lab Med 2004;42:455–461. [DOI] [PubMed] [Google Scholar]
  • 18. Sharma R, Gaze DC, Pellerin D, et al. Ischemia‐modified albumin predicts mortality in ESRD. Am J Kidney Dis 2006;47:493–502. [DOI] [PubMed] [Google Scholar]
  • 19. Christenson RH, Duh SH, Sanhai WR, et al. Characteristics of an albumin cobalt binding test for assessment of acute coronary syndrome patients: a multicenter study. Clin Chem 2001;47:464–470. [PubMed] [Google Scholar]
  • 20. Berenshtein E, Mayer B, Goldberg C, Kitrossky N, Chevion M. Patterns of mobilization of copper and iron following myocardial ischemia: possible predictive criteria for tissue injury. J Mol Cell Cardiol 1997;29:3025–3034. [DOI] [PubMed] [Google Scholar]
  • 21. Mothes E, Faller P. Evidence that the principal CoII‐binding site in human serum albumin is not at the N‐terminus: implication on the albumin cobalt binding test for detecting myocardial ischemia. Biochemistry 2007;46:2267–2274. [DOI] [PubMed] [Google Scholar]
  • 22. Valentini J, Schmitt GC, Grotto D, et al. Human erythrocyte delta‐aminolevulinate dehydratase activity and oxidative stress in hemodialysis patients. Clin Biochem 2007;40:591–594. [DOI] [PubMed] [Google Scholar]
  • 23. Roy D, Kaski JC. Ischemia‐modified albumin: the importance of oxidative stress. J Am Coll Cardiol 2007;49:2375–2376. [DOI] [PubMed] [Google Scholar]
  • 24. Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart 2006;92:113–114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Chan B, Dodsworth N, Woodrow J, Tucker A, Harris R. Site‐specific N‐terminal auto‐degradation of human serum albumin. Eur J Biochem 1995;227:524–528. [DOI] [PubMed] [Google Scholar]
  • 26. Lippi G, Montagnana M, Salvagno GL, Guidi GC. Standardization of ischemia‐modified albumin testing: adjustment for serum albumin. Clin Chem Lab Med 2007;45:261–262. [DOI] [PubMed] [Google Scholar]
  • 27. Lee YW, Kim HJ, Cho YH, Shin HB, Choi TY, Lee YK. Application of albumin‐adjusted ischemia modified albumin index as an early screening marker for acute coronary syndrome. Clin Chim Acta 2007;384:24–27. [DOI] [PubMed] [Google Scholar]
  • 28. Roach RC, Koskolou MD, Calbet JA, Saltin B. Arterial O2 content and tension in regulation of cardiac output and leg blood flow during exercise in humans. Am J Physiol 1999;276:H438–H445. [DOI] [PubMed] [Google Scholar]
  • 29. Saltin B, Kiens B, Savard G, Pedersen PK. Role of haemoglobin and capillarization for oxygen delivery and extraction in muscular exercise. Acta Physiol Scand 1986;128:21–32. [PubMed] [Google Scholar]
  • 30. Haaland K, Kofstad J, Apricena F, Thoresen M. Haemoglobin is inversely related to plasma lactate and heart rate in the newborn piglet. Biol Neonate 1996;69:350–356. [DOI] [PubMed] [Google Scholar]
  • 31. Gregg SG, Mazzeo RS, Budinger TF, Brooks GA. Acute anemia increases lactate production and decreases clearance during exercise. J Appl Physiol 1989;67:756–764. [DOI] [PubMed] [Google Scholar]
  • 32. Ohira Y, Chen CS, Hegenauer J, Saltman P. Adaptations of lactate metabolism in iron‐deficient rats. Proc Soc Exp Biol Med 1983;173:213–216. [DOI] [PubMed] [Google Scholar]
  • 33. Koukourakis MI, Giatromanolaki A, Polychronidis A, et al. Endogenous markers of hypoxia/anaerobic metabolism and anemia in primary colorectal cancer. Cancer Sci 2006;97:582–588. [DOI] [PMC free article] [PubMed] [Google Scholar]

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