Date of Conferral

2015

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Scott McDoniel

Abstract

Albumin provides the vital scaffolding for growth and tissue repair and supports oncotic blood pressure and hemodynamics. In hemodialysis patients, albumin aids with fluid removal by drawing excess fluid from edematous tissues back into the blood where it can then be removed by a dialyzer. The hyperglycemia seen in dialysis patients with Type II diabetes progressively damages kidney glomeruli, which permits albumin seepage into the urine, thus lowering serum albumin. The conceptual framework underpinning this research is the van't Hoff theory of osmotic pressure. Under this framework, the solute-solvent relationship largely contributes to the osmotic movement of fluid. The purpose of this study was to determine if albumin levels differed in Hispanics on dialysis with and without diabetes and if potential differences existed over time. Differences in diabetes incidence in Hispanics suggest albumin levels may be dissimilar. Albumin physiology is abundant in the literature; how and to what magnitude albumin levels are affected in patients with diabetes is unclear. This quantitative, retrospective cohort study employed ANOVA, Repeated Measures t tests, Spearman Correlation, and regression analysis to evaluate potential associations between the research variables. Data were extracted from CMS-2728 forms to amass the final cohort (N = 827). Differences in albumin levels at the first 2 intervals were observed (Baseline 1.29 ± 0.49 mg/dL, F = 2.28, p < .032; 3 months 0.47 ±0.41 mg/dL, F = 1.62, p < .004). Covariables (hypertension, peripheral vascular disease, and infections) were controlled for but showed inconclusive results. Lower serum albumin in Hispanic dialysis patients with diabetes provides the impetus for developing ethnic-specific albumin therapies, thus promoting positive social change.

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