Serum β-2 microglobulin levels predict mortality in dialysis patients:: Results of the HEMO study
Serum β-2 microglobulin levels predict mortality in dialysis patients:: Results of the HEMO study
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DOI：
10.1681/asn.2005020132
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发表时间：
2006-02-01
影响因子：
13.6
通讯作者：
Eknoyan, Garabed
中科院分区：
文献类型：
--
作者：
Cheung, Alfred K.;Rocco, Michael V.;Eknoyan, Garabed
在随机血液透析（HEMO）研究中，与低通量透析相比，慢性高通量透析（定义为β 2微球蛋白（β M-2）清除率较高）并未显著改变整个队列的全因死亡率，但与长期透析患者的死亡率较低相关。该分析检查了血清β M-2水平的决定因素以及血清β M-2水平或透析器β M-2清除率与死亡率的相关性。在一项检查了1704例患者的多变量回归模型中，基线残留肾尿素清除率和透析器β M-2清除率是随访1个月时透析前血清β M-2水平的强预测因子，回归系数分别为-7.21（+/- 0.69 SE）mg/L/ml/min/35 L尿素体积（P < 0.0001）和-1.94（+/- 0.30）mg/L/ml/min（P < 0.0001）。此外，黑人种族和透析的基线年数与血清β M-2水平呈正相关，而年龄、糖尿病、血清白蛋白和体重指数与血清β M-2水平呈负相关（P < 0.05）。在时间依赖性考克斯回归模型中，平均累积透析前血清β M-2水平而不是透析器β M-2清除率与全因死亡率相关（相对风险= β M-2水平每增加10毫克/升1.11; 95%置信区间1.05至1.19; P = 0.001），校正残余肾尿素清除率和研究前透析年数后。这种关联支持β M-2作为指导慢性血液透析治疗的标志物的潜在价值。
sIn the randomized Hemodialysis (HEMO) Study, chronic high-flux dialysis, as defined by higher beta-2 microglobulin (beta M-2) clearance, compared with low-flux dialysis did not significantly alter all-cause mortality in the entire cohort but was associated with lower mortality in long-term dialysis patients. This analysis examined the determinants of serum beta M-2 levels and the associations of serum beta M-2 levels or dialyzer beta M-2 clearance with mortality. In a multivariable regression model that examined 1704 patients, baseline residual kidney urea clearance and dialyzer beta M-2 clearance were strong predictors of predialysis serum beta M-2 levels at 1 mo of follow-up, with regression coefficients of -7.21 (+/- 0.69 SE) mg/L per ml/min per 35 L urea volume (P < 0.0001) and -1.94 (+/- 0.30) mg/L per ml/min (P < 0.0001),respectively. In addition, black race and baseline years on dialysis correlated positively whereas age, diabetes, serum albumin, and body mass index correlated negatively with serum beta M-2 levels (P < 0.05). In time-dependent Cox regression models, mean cumulative predialysis serum beta M-2 levels but not dialyzer beta M-2 clearance were associated with all-cause mortality (relative risk = 1.11 per 10-mg/L increase in beta M-2 level; 95% confidence interval 1.05 to 1.19; P = 0.001), after adjustment for residual kidney urea clearance and number of prestudy years on dialysis. This association is supportive of the potential value of beta M-2 as a marker to guide chronic hemodialysis therapy.