Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
Department of Research and Analysis, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
Nephrol Dial Transplant. 2019 Jan 1;34(1):138-145. doi: 10.1093/ndt/gfy193.
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.
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.
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).
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.
人们普遍认为，在维持性透析患者中，单次测量的血清β-2 微球蛋白（B2M）水平升高与死亡率显著相关。迄今为止，大多数研究 B2M 与死亡率相关的研究都是在残余肾功能（RRF）较少的现患血液透析患者中进行的。然而，在新发生的腹膜透析（PD）患者中缺乏相关研究。此外，在该人群中，未考虑血清 B2M 水平随时间的变化。
我们使用 Cox 比例风险回归分析，检查了 725 例新发生 PD 患者的 10 年队列中，时间更新和基线血清 B2M 水平与死亡率之间的关联。患者根据 B2M 水平分为三分位组。
在中位随访 38（四分位间距 23-64）个月期间，发生了 258 例（35.4%）死亡，其中心血管和感染原因分别导致 106 例（14.6%）和 86 例（11.9%）死亡。最低 B2M 三分位组与全因和感染性死亡风险较高相关，与中间三分位组相比：全因死亡的风险比（95%置信区间）在时变分析中分别为 2.12（1.38-3.26）和 2.20（0.96-5.05），在基线分析中分别为 1.52（1.07-2.17）和 2.41（1.19-4.88）。亚组分析表明，这种相关性在女性、年龄较大的患者、患有糖尿病等合并症、较低的体重指数、较低的白蛋白水平或 RRF 较高的患者中尤为明显（所有 P 值交互作用均<0.05）。
在新发生的 PD 患者中，较低的 B2M 水平与全因和感染性死亡率独立相关。这些关联可能会被营养不良、炎症和 RRF 改变。
