Abstract: Objective Hypoalbuminemia is prevalent in patients on maintenance peritoneal dialysis (PD), which can predict cardiovascular events and mortality. Amelioration of the hypoalbuminemia is critical for the improvement of clinical outcome in PD patients. Our aim is to develop and implement a clinical pathway to improve the hypoalbuminemia and then to observe its efficacy. Methods This was a self- control study. Between May 1, 2014 and Oct. 31, 2014, we enrolled clinically stable PD patients from Peking University First Hospital. According to the mechanism for hypoalbuminemia, we developed a clinical pathway to root for the causes of hypoalbuminemia and then took measures including dietary counseling, dialysis regime adjustment, volume control, and dealing with comorbidities to improve serum albumin. We aimed to explore if these interventions could improve serum albumin after 3 months and 6 months. Results ①The average age of participants was 63.35 ±13.48 years, with 58 (44.3%) men, and 76 (58%) diabetes. The median dialysis duration was 35 (11～70) months. The causes for hypoalbuminemia were comorbidities (45, 34.4%), insufficient protein and calorie intake (43, 32.8%), inadequate dialysis (4, 3.1%), volume overload (4, 3.1%), loss of protein (1, 0.8%), other factors (17, 13%), and miscellaneous (17, 13%). ②By general linear model analysis, serum albumin significantly increased to 33.3±4.2 g/L at the 3rd month and 34.6±3.7g/L at the 6th month from the baseline value after adjusting for age, gender and dialysis duration. Serum albumin values at the 6th month were also higher than those at the 3rd month (P=0.021) and at the baseline (P=0.032). Further analysis showed that the increasing trend of serum albumin was comparable between non-diabetes and diabetes, patients with dialysis duration longer and shorter than 36 months, and patients with high- sensitive C-reactive protein higher and lower than 4.06 g/L. Conclusions Based on the clinical pathway for ameliorating hypoalbuminemia in PD patients, we can significantly increase the value of serum albumin. The finding needs to be verified in further studies with large sample sizes.

Key words: Peritoneal dialysis, hypoalbuminemia, clinical pathway