NDT Advance Access published online on September 17, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn521
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Serum β2-microglobulin level is a significant predictor of mortality in maintenance haemodialysis patients
1 Kidney Center, Shirasagi Hospital 2 Osaka City University Graduate School of Medicine, Osaka, Japan
Correspondence and offprint requests to: Eiji Ishimura, Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. Tel: +81-6-6645-3806; Fax: +81-6-6645-3808; E-mail: ish{at}med.osaka-cu.ac.jp
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Abstract |
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Background. β2-Microglobulin (β2-M) is recognized as a surrogate marker of middle-molecule uraemic toxins and is a key component in the genesis of dialysis-associated amyloidosis. Few studies have evaluated the association of β2-M levels with clinical outcome in dialyzed patients.
Methods. The prognostic implication of serum β2-M levels for the survival of haemodialysis patients was examined in 490 prevalent haemodialysis patients (60.1 ± 11.8 years, haemodialysis duration of 87.4 ± 75.7 months, 288 males and 202 females; 24% diabetics). The patients were divided into two groups according to their serum β2-M levels: lower β2-M group (n = 245) with serum β2-M <32.2 mg/L (the median serum β2-M) and higher β2-M group (n = 245) with that 
32.2 mg/L.
Results. During the follow-up period of 40 ± 15 months, there were 91 all-cause deaths, and out of them, 36 were from cardiovascular diseases. Kaplan–Meier analysis revealed that all-cause mortality in the higher β2-M group was significantly higher compared to that in the lower β2-M group (P < 0.001). Multivariate Cox proportional hazards analyses showed that serum β2-M level was a significant predictor for all-cause mortality (hazard ratio, 1.05; 95% CI, 1.01–1.08; P = 0.005), and for non-cardiovascular mortality (hazard ratio, 1.06; 95% CI, 1.02–1.10; P = 0.006), after adjustment for age, gender, haemodialysis duration, the presence of diabetes, serum albumin and serum C-reactive protein.
Conclusion. These results demonstrate that the serum β2-M level is a significant predictor of mortality in haemodialysis patients, independent of haemodialysis duration, diabetes, malnutrition and chronic inflammation, suggesting the clinical importance of lowering serum β2-M in these patients.
Keywords: haemodialysis; mortality; non-cardiovascular mortality; β2-microglobulin
Received for publication: 31. 3.08
Accepted in revised form: 25. 8.08
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