Skip to content

Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Serum albumin

In short

Albumin is a protein in your blood. It carries calcium and other substances, and it helps keep fluid in your blood from leaking into the tissues (MedlinePlus). On dialysis, a low albumin goes with a higher risk of hospital stays and death (KDOQI 2020, statement 1.2.2). But it is not a nutrition test on its own: infection and inflammation, protein lost in the urine, liver disease and other things lower it too (KDOQI 2020, statement 1.2.1; MedlinePlus). Serum albumin is a blood test. It is not the same as urine albumin, which is the UACR test of kidney damage.

Your numbers

Value
Typical range 3.4–5.4 g/dL (your lab's range wins)
Kidney nutrition-risk cut-off under 3.8 g/dL, measured by the bromocresol green method
Value
Typical range 34–54 g/L (your lab's range wins)
Kidney nutrition-risk cut-off under 38 g/L, measured by the bromocresol green method

Range from MedlinePlus. The 3.8 g/dL cut-off is one of the criteria for protein-energy wasting, a kind of malnutrition seen in kidney disease (ISRNM 2008). To convert, multiply g/dL by 10 to get g/L.

Lab methods differ. Labs measure albumin in different ways. On hemodialysis the bromocresol green method tends to read high and the bromocresol purple method low. In a Dutch study of about 500 people on hemodialysis, centers using the purple method reported an average albumin of 34.5 g/L and centers using the green method 40.3 g/L (de Roij van Zuijdewijn 2018). So a result that counts as "low" at one lab may count as "normal" at another. Ask which method your lab uses, and compare results from the same lab.

How often. US dialysis units must measure albumin and weight at least once a month (42 CFR 494.90). Before dialysis, ask your team how often you need it.

What lowers albumin

Cause What it means for you
Not eating enough protein or calories A dietitian can help; see Eating enough and Protein
Infection or inflammation Albumin falls with illness and inflammation whatever you eat, so it is best rechecked when you are well (KDOQI 2020, statement 1.2.1 and its rationale)
Protein lost in the urine (UACR in the A3 range) or into peritoneal dialysis fluid Low albumin is common with heavy urine protein and on peritoneal dialysis (KDIGO 2022; KDOQI 2020)
Liver disease, or gut conditions that block absorption (MedlinePlus)

A result can read high with dehydration, or if the tourniquet was left on too long during the blood draw (MedlinePlus).

Albumin changes other results. About half of the calcium in blood is carried on albumin, so a low albumin makes total calcium look low (MedlinePlus; Phosphate, calcium and PTH). Low albumin can also throw off glycated albumin and fructosamine, two glucose tests sometimes used instead of A1c (KDIGO 2022; A1c).

Other signs of poor nutrition

Because albumin alone is not enough, teams look at several things together (KDOQI 2020, statement 1.2.1):

  • Weight loss you did not plan: more than 5 % in 3 months or more than 10 % in 6 months (ISRNM 2008). For a 70 kg person, 5 % is 3.5 kg (about 8 lb).
  • A poor appetite, eating less than usual, or muscles getting thinner and weaker.
  • Grip strength, when there are earlier results to compare (KDOQI 2020, statement 1.3.1).

What to do

  • Weigh yourself once a week at the same time (after dialysis if you are on hemodialysis) and write it down.
  • If your albumin is low or your weight is falling, ask to see a renal dietitian.
  • Ask whether an oral nutrition supplement (a renal nutrition drink) would help. KDOQI suggests at least a 3-month trial when diet advice alone is not enough (KDOQI 2020, statement 4.1.1).
  • On dialysis, eat enough protein: more is needed, not less (Protein).
  • With type 1 diabetes, eating less with the same insulin can cause lows. Tell your diabetes team when your appetite drops (Eating enough; Treating a low).
  • Get infections treated, and recheck albumin when you are well.

In the app

Add an albumin result under Labs. Under 3.8 g/dL the app marks a nutrition risk and moves your suggested protein and calories to the higher end, with a note that low albumin can also come from inflammation or urine protein, and that labs measure it in different ways (design note 05). See Targets and warnings.

Examples

  • After pneumonia. On hemodialysis, Ruth's albumin fell from 3.9 to 3.3 g/dL after a chest infection. Her appetite is coming back. Her dietitian adds a renal nutrition drink and rechecks next month.
  • Protein in the urine. Omar's albumin is 3.4 g/dL and his UACR is 2,500 mg/g. Much of his albumin is being lost in his urine, so his kidney team focuses on lowering the UACR (UACR).
  • Two labs. Sara's albumin was 3.6 at a hospital lab and 4.1 at her dialysis unit in the same month. Different methods can explain a gap like this; her team compares results from one lab only.

Ask your care team

  1. Is my albumin low for my lab's method?
  2. Could inflammation, an infection or urine protein be the cause?
  3. Am I eating enough protein and calories? Can I see a renal dietitian?
  4. Would a nutrition drink help? Which kind fits my potassium, phosphorus and fluid limits?
  5. Is my weight change something to worry about?

Get help now if…

A low albumin is not an emergency on its own.

Call 911 (or your local emergency number)

You cannot keep liquids down for more than 4 hours, or you have ketones with vomiting (CDC; Sick days); or you are very short of breath or cannot lie flat. See Get help now.

Call your care team today

You are eating much less than usual, you have vomiting or diarrhea (check your ketones and start your sick-day plan), or you have new swelling or sudden weight gain.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.