CEA Levels in Dialysis Patients: What You Need to Know

Dialysis - CEA (Carcinoembryonic Antigen)

A family member has been on dialysis for about 7 years.
Due to low albumin levels, they developed pleural effusion and loss of appetite.
After hospitalization, the pleural effusion has improved.
Currently, the hospital nutritionist recommends high-protein powder along with dietary intake of fish and meat.
From October 2018 to February 2019, the albumin level increased from 1.9 to 3.89, and the generalized edema has completely resolved, allowing for a normal diet.
I would like to ask if CEA levels in dialysis patients are typically higher than in the general population?

Jia Ling, 30~39 year old female. Ask Date: 2019/03/25

Dr. Wu Hongjie reply Internal Medicine

There are many interfering factors for CEA, including older age and smoking.
Additionally, CEA levels in dialysis patients may also be higher than normal.
CEA is used as a marker for "monitoring" colorectal cancer, not for "diagnosis." The upper limit of CEA for smokers is approximately 5, while in dialysis patients, levels exceeding twice the upper limit are more clinically significant.
It is recommended that if there is a need to confirm the presence of colorectal cancer, biopsy reports and endoscopic examinations should be prioritized.
Wishing you health and safety.

Reply Date: 2019/03/25

More Info

Understanding CEA Levels in Dialysis Patients: What You Need to Know
Carcinoembryonic antigen (CEA) is a glycoprotein involved in cell adhesion, and it is primarily used as a tumor marker in the diagnosis and management of certain types of cancers, particularly adenocarcinomas such as colorectal, gastric, and lung cancers. In patients undergoing dialysis, the interpretation of CEA levels can be complex due to various factors that can influence these levels.

Firstly, it is essential to understand that CEA is not exclusively indicative of cancer. Elevated CEA levels can occur in non-cancerous conditions, including chronic inflammatory diseases, liver diseases, and even in smokers. In dialysis patients, particularly those with chronic kidney disease (CKD), CEA levels can be affected by the underlying health conditions, nutritional status, and the presence of other comorbidities.

In your case, your family member has been on dialysis for about seven years and has experienced low albumin levels, which can lead to complications such as pleural effusion and decreased appetite. The improvement in albumin levels from 1.9 to 3.89 indicates a positive response to nutritional interventions, including the incorporation of high-protein foods and supplements. This nutritional improvement is crucial, as low albumin levels can lead to a range of health issues, including increased risk of infections and poor wound healing.

Regarding CEA levels in dialysis patients, it is not uncommon for these levels to be higher than those in the general population. This elevation can be attributed to several factors:
1. Inflammation: Dialysis patients often experience chronic inflammation, which can lead to increased CEA production. Conditions such as infections, autoimmune diseases, or even the dialysis process itself can contribute to elevated CEA levels.

2. Nutritional Status: Malnutrition is prevalent in dialysis patients, and it can affect the metabolism of various proteins, including CEA. As your family member's nutritional status improves, it may also influence CEA levels.

3. Underlying Conditions: The presence of other health issues, such as liver disease or malignancies, can also elevate CEA levels. Given your family member's history and current health status, it is essential to monitor these levels closely.

4. Dialysis Method: The type of dialysis (hemodialysis vs. peritoneal dialysis) and the frequency of treatments can also impact CEA levels. Hemodialysis, for instance, may remove certain proteins from the bloodstream, potentially affecting the levels of CEA.

In conclusion, while elevated CEA levels in dialysis patients can be concerning, they do not automatically indicate the presence of cancer. It is crucial to interpret these levels in the context of the patient's overall health, nutritional status, and any underlying conditions. Regular monitoring and follow-up with healthcare providers, including nephrologists and oncologists if necessary, are essential for managing health in dialysis patients. If there are concerns about elevated CEA levels, further investigations, such as imaging studies or additional blood tests, may be warranted to rule out malignancies or other serious conditions.

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