Association Between Serum β-microglobulin Levels and the Risk of All-cause and Cardiovascular Disease Mortality in Chinese Patients Undergoing Maintenance Hemodialysis

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2023 Jun 13

PMID 37312042

Authors

Yu-Xin Jin

Shuang Zhang

Jia Xiao

Zhi-Hong Wang

Cui Dong

Lian-Lian You

Ting-Ting Kuai

Yu Zhang

Shu-Xin Liu

Affiliations

Soon will be listed here.

Abstract

Background: The association between serum β-microglobulin (βM) levels and the risk of all-cause and cardiovascular disease (CVD) mortality and the incidence of cardiovascular events (CVEs) in patients undergoing maintenance hemodialysis (MHD) is inconclusive. Furthermore, no study has been performed in China on the significance of serum βM levels in MHD patients. Therefore, this study investigated the aforementioned association in MHD patients.

Methods: In this prospective cohort study, 521 MHD patients were followed at Dalian Municipal Central Hospital affiliated with Dalian University of Technology from December 2019 to December 2021. The serum βM levels were categorized into three tertiles, and the lowest tertile served as the reference group. Survival curves were calculated by the Kaplan-Meier method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models. Sensitivity analysis was performed by excluding patients with CVD at baseline.

Results: During the follow-up period of 21.4 ± 6.3 months, there were 106 all-cause deaths, of which 68 were caused by CVD. When excluding CVD patients at baseline, there were 66 incident CVEs. Kaplan-Meier analysis revealed that the risk of all-cause and CVD mortality in the highest tertile of serum βM levels was significantly higher than that in the lowest tertile (P < 0.05), but not for the CVEs (P > 0.05). After adjusting for potential confounders, serum βM levels were positively associated with the risk of all-cause (HR = 2.24, 95% CI = 1.21-4.17) and CVD (HR = 2.54, 95% CI = 1.19-5.43) mortality, and a linear trend was evident (P < 0.05). Besides, the results of sensitivity analysis were consistent with the main findings. However, we didn't observed the significant association between serum βM levels and CVEs (P > 0.05).

Conclusion: The serum βM level may be a significant predictor of the risk of all-cause and CVD mortality in MHD patients. Further studies are needed to confirm this finding.

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References

Kanda E, Muenz D, Bieber B, Cases A, Locatelli F, Port F . Beta-2 microglobulin and all-cause mortality in the era of high-flux hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study. Clin Kidney J. 2021; 14(5):1436-1442. PMC: 8087125. DOI: 10.1093/ckj/sfaa155. View

Fujii H, Goto S, Fukagawa M . Role of Uremic Toxins for Kidney, Cardiovascular, and Bone Dysfunction. Toxins (Basel). 2018; 10(5). PMC: 5983258. DOI: 10.3390/toxins10050202. View

Cheung A, Greene T, Leypoldt J, Yan G, Allon M, Delmez J . Association between serum 2-microglobulin level and infectious mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2007; 3(1):69-77. PMC: 2390979. DOI: 10.2215/CJN.02340607. View

Cheung A, Rocco M, Yan G, Leypoldt J, Levin N, Greene T . Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol. 2005; 17(2):546-55. DOI: 10.1681/ASN.2005020132. View

Xie J, Yi Q . Beta2-microglobulin as a potential initiator of inflammatory responses. Trends Immunol. 2003; 24(5):228-9; author reply 229-30. DOI: 10.1016/s1471-4906(03)00076-0. View

Drueke T, Massy Z . Beta2-microglobulin. Semin Dial. 2009; 22(4):378-80. DOI: 10.1111/j.1525-139X.2009.00584.x. View

Zumrutdal A, Sezer S, Demircan S, Seydaoglu G, Ozdemir F, Haberal M . Cardiac troponin I and beta 2 microglobulin as risk factors for early-onset atherosclerosis in patients on haemodialysis. Nephrology (Carlton). 2005; 10(5):453-8. DOI: 10.1111/j.1440-1797.2005.00475.x. View

Groot K, Bahlmann F, Sowa J, Koenig J, Menne J, Haller H . Uremia causes endothelial progenitor cell deficiency. Kidney Int. 2004; 66(2):641-6. DOI: 10.1111/j.1523-1755.2004.00784.x. View

Fry A, Singh D, Chandna S, Farrington K . Relative importance of residual renal function and convection in determining beta-2-microglobulin levels in high-flux haemodialysis and on-line haemodiafiltration. Blood Purif. 2007; 25(3):295-302. DOI: 10.1159/000104870. View

10.

Vincent C, Revillard J . Beta-2-microglobulin and HLA-related glycoproteins in human urine and serum. Contrib Nephrol. 1981; 26:66-88. DOI: 10.1159/000396105. View

11.

Sarnak M, Levey A . Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis. 2000; 35(4 Suppl 1):S117-31. DOI: 10.1016/s0272-6386(00)70239-3. View

12.

Chen N, ONeill K, Niwa T, Moe S . Signal transduction of beta2m-induced expression of VCAM-1 and COX-2 in synovial fibroblasts. Kidney Int. 2002; 61(2):414-24. DOI: 10.1046/j.1523-1755.2002.00136.x. View

13.

Hole B, Hemmelgarn B, Brown E, Brown M, McCulloch M, Zuniga C . Supportive care for end-stage kidney disease: an integral part of kidney services across a range of income settings around the world. Kidney Int Suppl (2011). 2020; 10(1):e86-e94. PMC: 7031687. DOI: 10.1016/j.kisu.2019.11.008. View

14.

Andrassy K . Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'. Kidney Int. 2013; 84(3):622-3. DOI: 10.1038/ki.2013.243. View

15.

Floege J, Bartsch A, Schulze M, Shaldon S, Koch K, Smeby L . Clearance and synthesis rates of beta 2-microglobulin in patients undergoing hemodialysis and in normal subjects. J Lab Clin Med. 1991; 118(2):153-65. View

16.

Johansen K, Chertow G, Gilbertson D, Herzog C, Ishani A, Israni A . US Renal Data System 2021 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2022; 79(4 Suppl 1):A8-A12. PMC: 8935019. DOI: 10.1053/j.ajkd.2022.02.001. View

17.

Lekawanvijit S . Cardiotoxicity of Uremic Toxins: A Driver of Cardiorenal Syndrome. Toxins (Basel). 2018; 10(9). PMC: 6162485. DOI: 10.3390/toxins10090352. View

18.

Kim K, Kim S, Kim H, Koo T, Im E, Kim S . Higher serum beta2-microglobulin levels are associated with better survival in chronic hemodialysis patients: a reverse epidemiology. Clin Nephrol. 2011; 75(5):458-65. DOI: 10.5414/cnp75458. View

19.

Anders H, Andersen K, Stecher B . The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease. Kidney Int. 2013; 83(6):1010-6. DOI: 10.1038/ki.2012.440. View

20.

Foster M, Coresh J, Hsu C, Xie D, Levey A, Nelson R . Serum β-Trace Protein and β2-Microglobulin as Predictors of ESRD, Mortality, and Cardiovascular Disease in Adults With CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2016; 68(1):68-76. PMC: 4921300. DOI: 10.1053/j.ajkd.2016.01.015. View