Serum beta 2 -microglobulin and immunoglobulin levels in young hemodialysis patients

Abstract

Amyloidosis is a complication of long-term hemodialysis treatment. The major histological feature of hemodialysis-associated amyloidosis (HAA) is the deposition of amyloid fibrils in the affected lesions, due, in part, to elevated serum beta2-microglobulin (beta2M) levels. In vitro studies reveal that serum immunoglobulin light and heavy chains co-deposit with beta2M in tissues affected by HAA. Only one study of HAA has been performed in young dialysis patients. We therefore assessed risk factors for HAA in a group (n=30) of young (18.7+/-0.9 years) patients receiving chronic, uninterrupted hemodialysis using cellulose acetate membranes. All patients initiated dialysis before reaching 18 years of age. The pre-dialysis serum beta2M level was 49.7+/-3.9 mg/l (normal 0-2.4 mg/l). Since serum albumin was normal (4.3+/-0.1 mg/dl) and serum protein/albumin was elevated (1.7+/-0.0, normal 1.2-1.5), indicating increased circulating protein, we assayed immunoglobulins in the same patients. The serum immunoglobulin levels (expressed as a percentage of the total level of serum proteins) were elevated (21.3+/-0.9%, normal 11.1%-21.0%). The Kt/v was 1.37+/-0.03, suggesting that the high levels of serum beta2M and immunoglobulins were not due to inadequate dialysis in these patients. Patients with residual renal function (Kr) did display significantly lower serum levels of beta2M (33.2+/-2.3, P=0.03). Furthermore, improved clearance of beta2M correlated with higher values of Kr (r=0.914). In contrast, serum levels of immunoglobulin (22.6+/-3.7, P=0.5) were unaffected by Kr. In addition, there was no correlation between older age at onset of dialysis and serum levels of either beta2M (r=0.107) or immunoglobulins (r=0.321). Finally, the length of time on dialysis had no effect on serum levels of either beta2M (r=0.105) or immunoglobulins (r=0.092). Taken together, these results indicate that young hemodialysis patients may be at risk for HAA.

Comparison of cystatin C and Beta‐2‐microglobulin kinetics in children on maintenance hemodialysis

“…B2M is the only MM studied in depth with respect to its kinetics, but its disadvantages are well known . It has a fluctuating production rate and complex rebound kinetics with high compartmentalization, elevated levels in nonrenal diseases, is affected by heparin and its production can increase during HD . Intradialytic rise in B2M was previously attributed to hemoconcentration with UF, but a true rise in intradialytic B2M production was demonstrated with higher dialyzer surface area and certain membrane types (Polymethylmethacrylate 2.0 m 2 , cuprophane and cellulose) .…”

“…It has a fluctuating production rate and complex rebound kinetics with high compartmentalization, elevated levels in nonrenal diseases, is affected by heparin and its production can increase during HD . Intradialytic rise in B2M was previously attributed to hemoconcentration with UF, but a true rise in intradialytic B2M production was demonstrated with higher dialyzer surface area and certain membrane types (Polymethylmethacrylate 2.0 m 2 , cuprophane and cellulose) . Proposed mechanisms for this rise include B2M release from leukocytes due to complement activation during HD, serum osmolar changes and presence of endotoxin‐like substances in dialysate, and cell shedding during passage through the dialyser .…”

“…However, it is an inadequate marker due to its fluctuating production rate, complex rebound kinetics with high compartmentalization and variation in levels in nonrenal diseases . Dialysis‐related rise in B2M was previously demonstrated and was associated with use of specific dialysis membranes and higher dialyzer surface area . Intradialytic solute accumulation affects assessment of HD adequacy and raises the toxic burden of the solute.…”

Is it time to revisit residual renal function in haemodialysis? (Review Article)

“…Less information is available in the published literature on this issue in HD patients. Studies have reported lower β 2 microglobulin levels, improved nutritional markers, an increase in true dry weight, higher haemoglobin and endogenous erythropoietin levels, lower potassium and uric acid levels, better phosphate balance and improved quality of life in HD patients with better preserved RRF 12,32–40 …”

“…Studies have reported lower b2 microglobulin levels, improved nutritional markers, an increase in true dry weight, higher haemoglobin and endogenous erythropoietin levels, lower potassium and uric acid levels, better phosphate balance and improved quality of life in HD patients with better preserved RRF. 12,[32][33][34][35][36][37][38][39][40] Residual renal function is also an important component of the overall treatment efficacy delivered by either PD or HD, and contributes to the success of the concept of incremental dialysis whereby patients with significant RRF can be initiated on smaller doses of dialysis at the beginning, hence according such patients better quality of life and less restrictions from the full dose of dialysis right from the onset.…”