title: Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study.
abstract: In the randomized Hemodialysis (HEMO) Study, chronic high-flux dialysis, as defined by higher beta-2 microglobulin (beta(2)M) 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(2)M levels and the associations of serum beta(2)M levels or dialyzer beta(2)M clearance with mortality. In a multivariable regression model that examined 1704 patients, baseline residual kidney urea clearance and dialyzer beta(2)M clearance were strong predictors of predialysis serum beta(2)M 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(2)M levels (P < 0.05). In time-dependent Cox regression models, mean cumulative predialysis serum beta(2)M levels but not dialyzer beta(2)M clearance were associated with all-cause mortality (relative risk = 1.11 per 10-mg/L increase in beta(2)M 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(2)M as a marker to guide chronic hemodialysis therapy.
authors.affiliation: VA Salt Lake City Healthcare System and Department of Medicine, University of Utah, Salt Lake City, Utah 84112, USA. alfred.cheung@hsc.utah.edu
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.forename: Guofen
authors.initials: G
authors.lastname: Yan
authors.forename: John K
authors.initials: JK
authors.lastname: Leypoldt
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Lawrence
authors.initials: L
authors.lastname: Agodoa
authors.forename: James
authors.initials: J
authors.lastname: Bailey
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.forename: William
authors.initials: W
authors.lastname: Clark
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Ornt
authors.forename: Gerald
authors.initials: G
authors.lastname: Schulman
authors.forename: Steven
authors.initials: S
authors.lastname: Schwab
authors.forename: Brendan
authors.initials: B
authors.lastname: Teehan
authors.forename: Garabed
authors.initials: G
authors.lastname: Eknoyan
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods; D013997:Time Factors; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D001613:beta 2-Microglobulin