Lower serum beta-2 microglobulin levels are associated with worse survival in incident peritoneal dialysis patients

Tae Ik Chang, Hyunsun Lim, Cheol Ho Park, Kyoung Sook Park, Jung Tak Park, Ea Wha Kang, TaeHyun Yoo, Shin-Wook Kang, SeungHyeok Han

Research output: Contribution to journalArticle

Abstract

Background There is a general consensus that elevated serum beta-2 microglobulin (B2M) levels measured at a single time-point are significantly associated with mortality in patients on maintenance dialysis. To date, the majority of prior studies that have examined B2M-associated mortality have been conducted in prevalent hemodialysis patients with little residual renal function (RRF). However, studies in incident peritoneal dialysis (PD) patients are lacking. Moreover, changes in serum B2M levels over time have not been considered in this population. Methods We examined the association of time-updated and baseline serum B2M levels with mortality in a 10-year cohort of 725 incident PD patients who were maintained on dialysis between January 2006 and December 2011 using Cox proportional hazards regression analyses. Patients were categorized into tertiles according to B2M levels. Results During a median follow-up of 38 (interquartile range 23-64) months, 258 (35.4%) deaths occurred, including 106 (14.6%) and 86 (11.9%) deaths from cardiovascular and infectious causes, respectively. The lowest B2M tertile was associated with a higher risk of all-cause and infectious mortality compared with the middle tertile: the hazard ratios (95% confidence interval) for all-cause deaths were 2.12 (1.38-3.26) and 2.20 (0.96-5.05) in time-varying analyses and 1.52 (1.07-2.17) and 2.41 (1.19-4.88) in baseline analyses. Subgroup analyses showed that this association was particularly observed in females, older patients, those with comorbidities such as diabetes, a lower body mass index, lower albumin levels or those with higher RRF (all P for interactions <0.05). Conclusions In incident PD patients, lower B2M levels were independently associated with overall and infectious mortality. These associations can be potentially modified by malnutrition, inflammation and RRF.

Original languageEnglish
Pages (from-to)138-145
Number of pages8
JournalNephrology Dialysis Transplantation
Volume34
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

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beta 2-Microglobulin
Peritoneal Dialysis
Survival
Serum
Mortality
Kidney
Dialysis
Malnutrition
Renal Dialysis
Comorbidity
Cause of Death
Albumins
Body Mass Index
Regression Analysis
Maintenance
Confidence Intervals
Inflammation
Population

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Chang, Tae Ik ; Lim, Hyunsun ; Park, Cheol Ho ; Park, Kyoung Sook ; Park, Jung Tak ; Kang, Ea Wha ; Yoo, TaeHyun ; Kang, Shin-Wook ; Han, SeungHyeok. / Lower serum beta-2 microglobulin levels are associated with worse survival in incident peritoneal dialysis patients. In: Nephrology Dialysis Transplantation. 2019 ; Vol. 34, No. 1. pp. 138-145.
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title = "Lower serum beta-2 microglobulin levels are associated with worse survival in incident peritoneal dialysis patients",
abstract = "Background There is a general consensus that elevated serum beta-2 microglobulin (B2M) levels measured at a single time-point are significantly associated with mortality in patients on maintenance dialysis. To date, the majority of prior studies that have examined B2M-associated mortality have been conducted in prevalent hemodialysis patients with little residual renal function (RRF). However, studies in incident peritoneal dialysis (PD) patients are lacking. Moreover, changes in serum B2M levels over time have not been considered in this population. Methods We examined the association of time-updated and baseline serum B2M levels with mortality in a 10-year cohort of 725 incident PD patients who were maintained on dialysis between January 2006 and December 2011 using Cox proportional hazards regression analyses. Patients were categorized into tertiles according to B2M levels. Results During a median follow-up of 38 (interquartile range 23-64) months, 258 (35.4{\%}) deaths occurred, including 106 (14.6{\%}) and 86 (11.9{\%}) deaths from cardiovascular and infectious causes, respectively. The lowest B2M tertile was associated with a higher risk of all-cause and infectious mortality compared with the middle tertile: the hazard ratios (95{\%} confidence interval) for all-cause deaths were 2.12 (1.38-3.26) and 2.20 (0.96-5.05) in time-varying analyses and 1.52 (1.07-2.17) and 2.41 (1.19-4.88) in baseline analyses. Subgroup analyses showed that this association was particularly observed in females, older patients, those with comorbidities such as diabetes, a lower body mass index, lower albumin levels or those with higher RRF (all P for interactions <0.05). Conclusions In incident PD patients, lower B2M levels were independently associated with overall and infectious mortality. These associations can be potentially modified by malnutrition, inflammation and RRF.",
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Lower serum beta-2 microglobulin levels are associated with worse survival in incident peritoneal dialysis patients. / Chang, Tae Ik; Lim, Hyunsun; Park, Cheol Ho; Park, Kyoung Sook; Park, Jung Tak; Kang, Ea Wha; Yoo, TaeHyun; Kang, Shin-Wook; Han, SeungHyeok.

In: Nephrology Dialysis Transplantation, Vol. 34, No. 1, 01.01.2019, p. 138-145.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Lower serum beta-2 microglobulin levels are associated with worse survival in incident peritoneal dialysis patients

AU - Chang, Tae Ik

AU - Lim, Hyunsun

AU - Park, Cheol Ho

AU - Park, Kyoung Sook

AU - Park, Jung Tak

AU - Kang, Ea Wha

AU - Yoo, TaeHyun

AU - Kang, Shin-Wook

AU - Han, SeungHyeok

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background There is a general consensus that elevated serum beta-2 microglobulin (B2M) levels measured at a single time-point are significantly associated with mortality in patients on maintenance dialysis. To date, the majority of prior studies that have examined B2M-associated mortality have been conducted in prevalent hemodialysis patients with little residual renal function (RRF). However, studies in incident peritoneal dialysis (PD) patients are lacking. Moreover, changes in serum B2M levels over time have not been considered in this population. Methods We examined the association of time-updated and baseline serum B2M levels with mortality in a 10-year cohort of 725 incident PD patients who were maintained on dialysis between January 2006 and December 2011 using Cox proportional hazards regression analyses. Patients were categorized into tertiles according to B2M levels. Results During a median follow-up of 38 (interquartile range 23-64) months, 258 (35.4%) deaths occurred, including 106 (14.6%) and 86 (11.9%) deaths from cardiovascular and infectious causes, respectively. The lowest B2M tertile was associated with a higher risk of all-cause and infectious mortality compared with the middle tertile: the hazard ratios (95% confidence interval) for all-cause deaths were 2.12 (1.38-3.26) and 2.20 (0.96-5.05) in time-varying analyses and 1.52 (1.07-2.17) and 2.41 (1.19-4.88) in baseline analyses. Subgroup analyses showed that this association was particularly observed in females, older patients, those with comorbidities such as diabetes, a lower body mass index, lower albumin levels or those with higher RRF (all P for interactions <0.05). Conclusions In incident PD patients, lower B2M levels were independently associated with overall and infectious mortality. These associations can be potentially modified by malnutrition, inflammation and RRF.

AB - Background There is a general consensus that elevated serum beta-2 microglobulin (B2M) levels measured at a single time-point are significantly associated with mortality in patients on maintenance dialysis. To date, the majority of prior studies that have examined B2M-associated mortality have been conducted in prevalent hemodialysis patients with little residual renal function (RRF). However, studies in incident peritoneal dialysis (PD) patients are lacking. Moreover, changes in serum B2M levels over time have not been considered in this population. Methods We examined the association of time-updated and baseline serum B2M levels with mortality in a 10-year cohort of 725 incident PD patients who were maintained on dialysis between January 2006 and December 2011 using Cox proportional hazards regression analyses. Patients were categorized into tertiles according to B2M levels. Results During a median follow-up of 38 (interquartile range 23-64) months, 258 (35.4%) deaths occurred, including 106 (14.6%) and 86 (11.9%) deaths from cardiovascular and infectious causes, respectively. The lowest B2M tertile was associated with a higher risk of all-cause and infectious mortality compared with the middle tertile: the hazard ratios (95% confidence interval) for all-cause deaths were 2.12 (1.38-3.26) and 2.20 (0.96-5.05) in time-varying analyses and 1.52 (1.07-2.17) and 2.41 (1.19-4.88) in baseline analyses. Subgroup analyses showed that this association was particularly observed in females, older patients, those with comorbidities such as diabetes, a lower body mass index, lower albumin levels or those with higher RRF (all P for interactions <0.05). Conclusions In incident PD patients, lower B2M levels were independently associated with overall and infectious mortality. These associations can be potentially modified by malnutrition, inflammation and RRF.

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