A review of albumin binding in CKD

Am J Kidney Dis. 2008 May;51(5):839-50. doi: 10.1053/j.ajkd.2007.12.035. Epub 2008 Mar 25.


Hypoalbuminemia is associated with excess mortality in patients with kidney disease. Albumin is an important oxidant scavenger and an abundant carrier protein for numerous endogenous and exogenous compounds. Several specific binding sites for anionic, neutral, and cationic ligands were described. Overall, the extent of binding depends on the ligand and albumin concentration, albumin-binding affinity, and presence of competing ligands. Chronic kidney disease affects all these determinants. This may result in altered pharmacokinetics and increased risk of toxicity. Renal clearance of albumin-bound solutes mainly depends on tubular clearance. Dialytic clearance by means of conventional hemodialysis/hemofiltration and peritoneal dialysis is limited. Other epuration techniques combining hemodialysis with adsorption have been developed. However, the benefit of these techniques remains to be proved.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Albumins / metabolism*
  • Albumins / physiology
  • Chronic Disease
  • Humans
  • Kidney Diseases / metabolism*
  • Kidney Diseases / physiopathology
  • Ligands
  • Protein Binding / physiology*


  • Albumins
  • Ligands