Kidney Week

Abstract: FR-PO825

Beta-2 Microglobulin Levels and All-Cause Mortality: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Session Information

• Dialysis: Hospitalization and Mortality
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada

Jeffrey Perl,

• Muenz, Daniel G., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Daniel G. Muenz,

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber,

• Cases, Aleix, Hospital Clinic, Barcelona, Barcelona, Spain

Aleix Cases,

• Kanda, Eiichiro, Kawasaki Medical School, Kurashiki, OKAYAMA, Japan

Eiichiro Kanda,

• Locatelli, Francesco, Azienda Socio Sanitaria Territoriale, Lecco, Italy

Francesco Locatelli,

• Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States

Hal Morgenstern,

• Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Friedrich K. Port,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

Background

Dialysis-related amyloidosis due to beta-2 microglobulin (β2M) accumulation among hemodialysis (HD) patients is now uncommon due to HD delivery improvements. The impact of β2M levels and other middle molecules on other adverse events among HD patients remains unclear. We sought to identify patient factors that may affect β2M level and estimate the effect of β2M on mortality.

Methods

Facilities in DOPPS phases 4-6 were included in this study if ≥50% of patients had β2M levels reported in ≥50% of follow-up rounds. Cox regression was used to estimate the association (hazard ratio [HR]; 95% CI) between β2M, categorized in tertiles, and all-cause mortality, adjusting for demographic factors, comorbidities, HD treatment factors, and stratified by study phase and region (Japan vs. Europe).

Results

We identified 5366 patients from 77 HD facilities in Japan (n=3837), France, Italy, and Spain (n=1529). Median (IQR) values of β2M (mg/dL) were 2.58 (2.17-3.00) in Japan and 2.55 (1.98-3.21) in Europe. In cross-sectional, unadjusted analysis, patients in the upper β2M tertile had longer dialysis vintage, greater likelihood of urine volume <200mL/day, lower prevalence of diabetes, higher serum phosphorus, and higher C-reactive protein, relative to the lower β2M tertile. Little association was observed between β2M and HD treatment time. Compared with the lower β2M tertile, the adjusted HR for mortality was 1.20 (0.98-1.48, 95% CI) for the middle tertile and 1.44 (1.17-1.75, 95% CI) for the upper tertile (Figure).

Conclusion

β2M is positively associated with mortality, controlling for several potential confounders. Interventions targeting greater β2M clearance during HD therapy may be an effective therapeutic strategy to improve outcomes among these patients.

Funding

• NIDDK Support – The DOPPS Program is supported by Amgen, Kyowa Hakko Kirin, Baxter Healthcare. Additional support for specific projects and countries is provided by AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Keryx, Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Proteon, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN) in the United Kingdom, and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health and not to Dr. Muenz directly.