title: Predicting residual kidney function in hemodialysis patients using serum β-trace protein and β2-microglobulin.
abstract: Residual kidney function (RKF) contributes significant solute clearance in hemodialysis patients. Kidney Diseases Outcomes Quality Initiative (KDOQI) guidelines suggest that hemodialysis dose can be safely reduced in those with residual urea clearance (KRU) of 2 ml/min/1.73 m(2) or more. However, serial measurement of RKF is cumbersome and requires regular interdialytic urine collections. Simpler methods for assessing RKF are needed. β-trace protein (βTP) and β2-microglobulin (β2M) have been proposed as alternative markers of RKF. We derived predictive equations to estimate glomerular filtration rate (GFR) and KRU based on serum βTP and β2M from 191 hemodialysis patients based on standard measurements of KRU and GFR (mean of urea and creatinine clearances) using interdialytic urine collections. These modeled equations were tested in a separate validation cohort of 40 patients. A prediction equation for GFR that includes both βTP and β2M provided a better estimate than either alone and contained the terms 1/βTP, 1/β2M, 1/serum creatinine, and a factor for gender. The equation for KRU contained the terms 1/βTP, 1/β2M, and a factor for ethnicity. Mean bias between predicted and measured GFR was 0.63 ml/min and 0.50 ml/min for KRU. There was substantial agreement between predicted and measured KRU at a cut-off level of 2 ml/min/1.73 m(2). Thus, equations involving βTP and β2M provide reasonable estimates of RKF and could potentially be used to identify those with KRU of 2 ml/min/1.73 m(2) or more to follow the KDOQI incremental hemodialysis algorithm.
authors.affiliation: Department of Nephrology, Lister Hospital, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Nephrology, Lister Hospital, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Sridharan
authors.affiliation: Department of Nephrology, Lister Hospital, Hertfordshire, UK.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Berdeprado
authors.affiliation: Department of Nephrology, Lister Hospital, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK.
authors.forename: Enric
authors.initials: E
authors.lastname: Vilar
authors.affiliation: Cambridge University Hospitals, Cambridge, UK.
authors.forename: Adie
authors.initials: A
authors.lastname: Viljoen
authors.affiliation: University of Hertfordshire, Hertfordshire, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wellsted
authors.affiliation: Department of Nephrology, Lister Hospital, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK. Electronic address: ken.farrington@nhs.net.
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019746:Intramolecular Oxidoreductases / Q000097:blood*; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D015203:Reproducibility of Results; D014508:Urea / Q000097:blood; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D015415:Biomarkers; D054834:Lipocalins; D001613:beta 2-Microglobulin; D014508:Urea; D003404:Creatinine; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase
keywords: beta 2 microglobulin; beta trace protein; hemodialysis; residual kidney function