Albumin determined by bromocresol green leads to erroneous results in routine evaluation of patients with chronic kidney disease

Marith Van Schrojenstein Lantman*, Anne Els Van De Logt, Elma Prudon-Rosmulder, Marloes Langelaan, Ayşe Y. Demir, Steef Kurstjens, Armando Van Der Horst, Aldy Kuypers, Aram Greuter, Jenny Kootstra-Ros, Eline Van Der Hagen, Marlies Oostendorp, Roseri De Beer, Christian Ramakers, Dirk Bakkeren, Fokke Lindeboom, Dennis Van De Wijngaart, Marc Thelen, Jack Wetzels, Miranda Van Berkel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
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Measurement of plasma albumin is pivotal for clinical decision-making in patients with chronic kidney disease (CKD). Routinely used methods as bromocresol green (BCG) and bromocresol purple (BCP) can suffer from aselectivity, but the impact of aselectivity on the accuracy of plasma albumin results of CKD-patients is still unknown. Therefore, we evaluated the performance of BCG-, BCP- and JCTLM-endorsed immunological methods in patients with various stages of CKD. 


We evaluated the performance of commonly used albumin methods in patients with CKD stages G1 through G5, the latter divided in two groups based on whether they received hemodialysis treatment. In total, 163 patient plasma samples were measured at 14 laboratories, on six different BCG and BCP-platforms, and four different immunological platforms. The results were compared with an ERM-DA-470k-corrected nephelometric assay. The implications on outcome is evaluated by the proportion of patient results <38g/L for the diagnosis of protein energy wasting. 


Albumin results determined with BCP- and immunological methods showed the best agreement with the target value (92.7 and 86.2%, respectively vs. 66.7% for BCG, namely due to overestimation). The relative agreement of each method with the target value was platform-dependent, with larger variability in agreement between platforms noted for BCG and immunological methods (3.2-4.6 and 2.6-5.3%) as opposed to BCP (0.7-1.5%). The stage of CKD had similar effects on the variability in agreement for the three method-groups (0.6-1.8% vs. 0.7-1.5% vs. 0.4-1.6%). The differences between methods cause discrepancies in clinical decision-making, as structurally fewer patients were diagnosed with protein energy wasting upon using BCG-based albumin results. 


Our study shows that BCP is fit for the intended use to measure plasma albumin levels in CKD patients from all stages, including patients on hemodialysis. In contrast, most BCG-based platforms falsely overestimate the plasma albumin concentration.

Original languageEnglish
Pages (from-to)2167-2177
Number of pages11
JournalClinical Chemistry and Laboratory Medicine
Issue number12
Early online date4 Jul 2023
Publication statusPublished - 1 Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 the author(s), published by De Gruyter, Berlin/Boston.


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