1
|
Huang PY, Hsu BG, Wang CH, Tsai JP. The Prognostic Role of Serum β-Trace Protein Levels among Patients on Maintenance Hemodialysis. Diagnostics (Basel) 2024; 14:974. [PMID: 38786272 PMCID: PMC11119092 DOI: 10.3390/diagnostics14100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiovascular (CV) diseases are the most commonly encountered etiology of mortality in patients having kidney failure. β-Trace protein (BTP) is a biomarker of glomerular filtration function as well as a potential predictor of adverse CV outcomes. This study aimed to determine the prognostic value of BTP in patients on chronic hemodialysis (HD). A total of 96 patients undergoing HD were enrolled. Baseline variables were collected, and the patients were tracked for 3 years. Twenty-five patients died at 3 years. Those who experienced mortality were noted to have higher serum concentrations of BTP and a higher incidence of diabetes mellitus (DM). The area under the receiver operating characteristic curve for serum BTP distinguishing mortality from survival was 0.659 (95% confidence interval [CI], 0.555-0.752; p = 0.027). After the adjustment of variables potentially affecting survival rates, BTP levels above the median (adjusted hazard ratio [aHR]: 2.913, 95% CI, 1.256-6.754; p = 0.013), the presence of DM (aHR: 2.474, 95% CI, 1.041-5.875; p = 0.040), and low serum albumin (aHR: 0.298, 95% CI, 0.110-0.806; p = 0.017) independently correlated with survival in HD patients. Serum BTP is a novel biomarker for predicting overall outcomes in HD patients.
Collapse
Affiliation(s)
- Po-Yu Huang
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| |
Collapse
|
2
|
Grubb A. Glomerular filtration and shrunken pore syndrome in children and adults. Acta Paediatr 2021; 110:2503-2508. [PMID: 33742469 DOI: 10.1111/apa.15846] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/10/2023]
Abstract
A major function of the kidney is to, by glomerular filtration, maintain the overall steady-state of 5-30 kDa proteins, many of which are signalling molecules. This function of the kidney has been overlooked, since predominantly low-molecular-mass substances <1 kDa have been used to measure or estimate glomerular filtration rate (GFR). The use of cystatin C (13 kDa) as a marker of GFR has allowed the discovery that the filtration of 5-30 kDa molecules can be selectively impaired defining the shrunken pore syndrome. The discovery, pathophysiology, morbidity (mainly cardiovascular manifestations) and mortality of this syndrome are described.
Collapse
Affiliation(s)
- Anders Grubb
- Department of Clinical Chemistry University Hospital Lund Sweden
| |
Collapse
|
3
|
Ciceri P, Cozzolino M. Expanded Haemodialysis as a Current Strategy to Remove Uremic Toxins. Toxins (Basel) 2021; 13:toxins13060380. [PMID: 34073439 PMCID: PMC8226798 DOI: 10.3390/toxins13060380] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by the retention of solutes named uremic toxins, which strongly associate with high morbidity and mortality. Mounting evidence suggests that targeting uremic toxins and/or their pathways may decrease the risk of cardiovascular disease in CKD patients. Dialysis therapies have been developed to improve removal of uremic toxins. Advances in our understanding of uremic retention solutes as well as improvements in dialysis membranes and techniques (HDx, Expanded Hemodialysis) will offer the opportunity to ameliorate clinical symptoms and outcomes, facilitate personalized and targeted dialysis treatment, and improve quality of life, morbidity and mortality.
Collapse
Affiliation(s)
- Paola Ciceri
- Renal Research Laboratory, Department of Nephrology, Dialysis and Renal Transplant, Fondazione Ca’ Granda IRCCS, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Correspondence: ; Tel.: +39-02-81844215
| |
Collapse
|
4
|
Leyssens K, Van Regenmortel N, Roelant E, Guerti K, Couttenye MM, Jorens PG, Verbrugghe W, Van Craenenbroeck AH. Beta-Trace Protein as a Potential Marker of Acute Kidney Injury: A Pilot Study. Kidney Blood Press Res 2021; 46:185-195. [PMID: 33784671 DOI: 10.1159/000514173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous glomerular filtration rate marker. The aim of this study was to explore the role of BTP as a marker of AKI. METHODS Patients admitted to the ICU undergoing surgery were included. BTP, sCr, Cystatin C (CysC), and neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively, postoperatively (post-op), and at the first (D1) and second (D2) post-op day. AKI was defined as an increase of sCr to ≥1.5-fold from baseline within 2 days after surgery. RESULTS Of the 52 patients studied, 10 patients (19%) developed AKI. Patients with AKI were older (69.6 ± 10.7 vs. 58.1 ± 16.7 years, p = 0.043) and had a longer length of ICU stay (13 [IQR 6-49] vs. 6 [IQR 5-8] days, p = 0.032). Between the 2 groups, the evolution of BTP, sCr, CysC, and NGAL over time differed significantly, with overall higher values in the AKI group. ROC analysis for the detection of AKI within 2 days after surgery showed a great accuracy for BTP. The area under the curve (AUC) for BTP post-op; D1; and D2 was, respectively, 0.869 ± 0.049; 0.938 ± 0.035; and 0.943 ± 0.032. The discriminative power of a BTP measurement on D1 was superior in detecting AKI compared to NGAL (adjusted p value = 0.027). We could not detect a significant difference between the AUCs of other biomarkers (NGAL, sCr, and CysC). CONCLUSION Serum BTP is a promising marker for diagnosing AKI in ICU patients undergoing surgery.
Collapse
Affiliation(s)
- Katrien Leyssens
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | | | - Ella Roelant
- Clinical Trial Center (CTC), Antwerp University Hospital, Edegem, Belgium
| | - Khadija Guerti
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Marie Madeleine Couttenye
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Walter Verbrugghe
- Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology and Renal Transplantation, University Hospital Leuven, Leuven, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
5
|
Schwab S, Kleine CE, Bös D, Bohmann S, Strassburg CP, Lutz P, Woitas RP. Beta-trace protein as a potential biomarker of residual renal function in patients undergoing peritoneal dialysis. BMC Nephrol 2021; 22:87. [PMID: 33706697 PMCID: PMC7953776 DOI: 10.1186/s12882-021-02287-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Residual renal function is closely linked to quality of life, morbidity and mortality in dialysis patients. Beta-trace protein (BTP), a low molecular weight protein, has been suggested as marker of residual renal function, in particular in patients on hemodialysis. We hypothesized that BTP also serves as a marker of residual renal function in pertioneal dialysis patients. Methods In this study 34 adult patients on peritoneal dialysis were included. BTP, creatinine, cystatin C and urea concentrations were analyzed simultaneously in serum and dialysate to calculate renal and peritoneal removal of the analytes. Results In peritoneal dialysis patients with residual diuresis, mean serum BTP was 8.16 mg/l (SD ± 4.75 mg/l). BTP correlated inversely with residual diuresis (rs = − 0.58, p < 0.001), residual creatinine clearance (ClCr) (rs = − 0.69, p < 0.001) and total urea clearance (Clurea) (rs = − 0.56, p < 0.001). Mean peritoneal removal of BTP was 3.36 L/week/1.73m2 (SD ± 1.38) and mean renal removal 15.14 L/week/1.73m2 (SD ± 12.65) demonstrating a significant renal contribution to the total removal. Finally, serum BTP inversely correlated with alterations in residual diuresis (r = − 0.41, p = 0.035) and renal creatinine clearance over time (r = − 0.79, p = p < 0.001). Conclusion BTP measurement in the serum may be a simple tool to assess residual renal function in peritoneal dialysis patients.
Collapse
Affiliation(s)
- Sebastian Schwab
- Department of Internal Medicine I, University of Bonn, Bonn, Germany. .,Institute of Experimental Immunology, Rheinische-Friedrichs-Wilhelms University of Bonn, Bonn, Germany.
| | | | | | | | | | - Philipp Lutz
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | |
Collapse
|
6
|
Obert LA, Elmore SA, Ennulat D, Frazier KS. A Review of Specific Biomarkers of Chronic Renal Injury and Their Potential Application in Nonclinical Safety Assessment Studies. Toxicol Pathol 2021; 49:996-1023. [PMID: 33576319 DOI: 10.1177/0192623320985045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A host of novel renal biomarkers have been developed over the past few decades which have enhanced monitoring of renal disease and drug-induced kidney injury in both preclinical studies and in humans. Since chronic kidney disease (CKD) and acute kidney injury (AKI) share similar underlying mechanisms and the tubulointerstitial compartment has a functional role in the progression of CKD, urinary biomarkers of AKI may provide predictive information in chronic renal disease. Numerous studies have explored whether the recent AKI biomarkers could improve upon the standard clinical biomarkers, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio, for predicting outcomes in CKD patients. This review is an introduction to alternative assays that can be utilized in chronic (>3 months duration) nonclinical safety studies to provide information on renal dysfunction and to demonstrate specific situations where these assays could be utilized in nonclinical drug development. Novel biomarkers such as symmetrical dimethyl arginine, dickkopf homolog 3, and cystatin C predict chronic renal injury in animals, act as surrogates for GFR, and may predict changes in GFR in patients over time, ultimately providing a bridge from preclinical to clinical renal monitoring.
Collapse
Affiliation(s)
- Leslie A Obert
- 549350GlaxoSmithKline (GSK), Nonclinical Safety, Collegeville, PA, USA
| | - Susan A Elmore
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), 6857National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Daniela Ennulat
- 549350GlaxoSmithKline (GSK), Nonclinical Safety, Collegeville, PA, USA
| | | |
Collapse
|
7
|
See YP, Htay H, Teixeira-Pinto A, Pascoe EM, Hawley C, Cho Y, Zhao E, Johnson DW. Utility of serum beta-trace protein as a tool for estimating residual kidney function in peritoneal dialysis patients. Perit Dial Int 2020; 41:226-235. [PMID: 32815791 DOI: 10.1177/0896860820945464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Beta-trace protein (BTP) is a novel marker for residual kidney function (RKF) without need for urinary collection. We aimed to examine its utility as a tool for estimating RKF in incident peritoneal dialysis (PD) patients. METHODS This was a post hoc analysis of incident PD patients from the balANZ trial cohort. The outcomes evaluated were trends of serum BTP concentration with time, factors associated with change in BTP using mixed-effect multilevel linear regression and correlation of BTP with mean urinary urea and creatinine clearances (measured glomerular filtration rate (GFR)). Performances of two BTP-derived equations (Shafi-Eqn and Steubl-Eqn) to estimate GFR were evaluated by reporting bias (median difference between estimated and measured GFR), precision (interquartile range of median bias), accuracy (±2 mL/min of measured GFR) and P30 (percentage estimates within 30% of measured GFR) with confidence intervals (CIs) generated by bootstrapping 2000 replicates. The agreement between BTP-estimated GFR and measured GFR was also plotted graphically on Bland-Altman analysis. RESULTS The study included 161 PD patients. BTP concentration increased with dialysis vintage and was inversely correlated with measured GFR (r = -0.64). Larger increases in BTP were associated with longer PD vintage and higher dialysate glucose exposure. Biases of BTP-estimated GFRs (Shafi-Eqn and Steubl-Eqn) were 1.2 mL/min/1.73 m2 (95% CI 1.0-1.3 mL/min/1.73 m2) and 0.4 mL/min/1.73 m2 (95% CI 0.2-0.6 mL/min/1.73 m2), respectively. Both BTP-estimated GFRs had poor precision (3.2 mL/min/1.73 m2 (95% CI 2.9-3.5 mL/min/1.73 m2) and 2.8 mL/min/1.73 m2 (95% CI 2.5-3.2 mL/min/1.73 m2), respectively) and accuracy of estimates (55% (95% CI 52-60%) and 59% (95% CI 55-63%), respectively). The mean difference of BTP-estimated GFR (Shafi-Eqn and Steubl-Eqn) and measured GFR were -1.14 mL/min/1.73 m2 and -0.42 mL/min/1.73 m2, respectively, with large limit of agreement on Bland-Altman plot. CONCLUSIONS Serum BTP level was inversely related to RKF but neither BTP-estimated GFR equations were sufficiently accurate for routine use in PD patients.
Collapse
Affiliation(s)
- Yong Pey See
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trial Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Renal Medicine, 63703Tan Tock Seng Hospital, Singapore
| | - Htay Htay
- Department of Renal Medicine, 37581Singapore General Hospital, Singapore
| | - Armando Teixeira-Pinto
- Faculty of Medicine and Health, Sydney School of Public Health, 4334University of Sydney, NSW, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trial Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trial Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trial Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Eileen Zhao
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trial Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
8
|
Bargnoux AS, Buthiau D, Morena M, Rodriguez A, Noguera-Gonzalez ME, Gilbert O, Le Quintrec M, Kuster N, Cristol JP. Estimation of residual renal function using beta-trace protein: Impact of dialysis procedures. Artif Organs 2020; 44:647-654. [PMID: 31951029 DOI: 10.1111/aor.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
Beta-trace protein (BTP), a low molecular weight protein of 23-29 kDa, has been proposed as a promising biomarker to estimate residual renal function (RRF) in patients on maintenance hemodialysis (HD). Indeed, BTP is cleared by native kidney but not during conventional HD session. By contrast, the removal rate of BTP using convective processes (mainly hemodiafiltration [HDF]) and peritoneal dialysis (PD) has been little or not investigated. Therefore, an aim of this study was to evaluate the impact of dialysis procedures (high-flux HD, on-line post-dilution HDF and PD) on BTP removal in comparison with beta-2 microglobulin (B2M) and cystatin C (CYSC) removals after a single session. In addition, the ability of BTP to predict RRF in PD was assessed. This observational cross-sectional study included a total of 82 stable chronic kidney disease patients, 53 patients were on maintenance dialysis (with n = 26 in HD and n = 27 in HDF) and 29 were on PD. Serum concentrations of BTP, B2M, and CYSC were measured (a) before and after a single dialysis session in HD and HDF anuric patients to calculate reduction percentages, (b) in serum, 24-hour-dialysate and 24-hour-urine in PD patients to compute total, peritoneal, and urinary clearance. RRF was estimated using four equations developed for dialysis patients without urine collection and compared to the mean of the urea and creatinine clearances in PD. The concentrations of the three studied molecules were significantly reduced (P < .001) after dialysis session with significantly higher reduction ratio using HDF compared to HD modality (P < .001): BTP 49.3% vs 17.5%; B2M 82.3% vs 69.7%; CYSC 77.4% vs 66% in HDF and HD, respectively. In non-anuric PD patients, B2M and CYSC were partly removed by peritoneal clearance (72.3% and 57.6% for B2M and CYSC, respectively). By contrast, BTP removal by the peritoneum was negligible and a low bias for the BTP-based equation to estimate RRF (-1.4 mL/min/1.73 m2 ) was calculated. BTP is significantly removed by high-flux HD or HDF, thereby compromising its use to estimate RRF. By contrast, BTP appears as a promising biomarker to estimate RRF in PD patients since it is not affected by peritoneal clearance, unlike B2M and CYSC, and it is well correlated to RRF.
Collapse
Affiliation(s)
- Anne-Sophie Bargnoux
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, Université de Montpellier, CHU de Montpellier, Montpellier Cedex 5, France
| | - Delphine Buthiau
- Département de Biochimie et Hormonologie, Université de Montpellier, CHU de Montpellier, Montpellier Cedex 5, France
| | - Marion Morena
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, Université de Montpellier, CHU de Montpellier, Montpellier Cedex 5, France
| | - Annie Rodriguez
- Département de Biochimie et Hormonologie, Université de Montpellier, CHU de Montpellier, Montpellier Cedex 5, France.,AIDER, Montpellier, France
| | - Maria-Eugenia Noguera-Gonzalez
- Département de Néphrologie, Dialyse et Transplantation, CHU de Montpellier, Université de Montpellier, Montpellier Cedex 5, France
| | | | - Moglie Le Quintrec
- Département de Néphrologie, Dialyse et Transplantation, CHU de Montpellier, Université de Montpellier, Montpellier Cedex 5, France
| | - Nils Kuster
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, Université de Montpellier, CHU de Montpellier, Montpellier Cedex 5, France
| | - Jean-Paul Cristol
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, Université de Montpellier, CHU de Montpellier, Montpellier Cedex 5, France
| |
Collapse
|
9
|
den Bakker E, Gemke RJ, van Wijk JA, Hubeek I, Stoffel-Wagner B, Bökenkamp A. Evidence for shrunken pore syndrome in children. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:32-38. [DOI: 10.1080/00365513.2019.1692231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Emil den Bakker
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Reinoud Jbj Gemke
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joanna Ae van Wijk
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Isabelle Hubeek
- Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Birgit Stoffel-Wagner
- Department of Clinical Chemistry and Clinical Pharmacology, University Clinics, Bonn, Germany
| | - Arend Bökenkamp
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Wolley MJ, Hutchison CA. Large uremic toxins: an unsolved problem in end-stage kidney disease. Nephrol Dial Transplant 2019; 33:iii6-iii11. [PMID: 30281131 PMCID: PMC6168891 DOI: 10.1093/ndt/gfy179] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/16/2018] [Indexed: 01/09/2023] Open
Abstract
Patients with end-stage kidney disease (ESKD) on maintenance hemodialysis are subject to a high burden of inflammation and cardiovascular disease, driven at least in part by retention of uremic solutes. Existing dialysis technologies using high-flux membranes offer limited clearance of solutes >15 kDa. New approaches to improve the removal of large uremic toxins include the novel medium cut-off dialysis membranes with pores larger than those in high-flux membranes. These new membranes provide the potential to improve the clearance of large middle molecules up to 50 kDa. In this review, we discuss 18 uremic toxins with molecular weights between 15 and 60 kDa that are retained in ESKD, for which there is evidence of a link to inflammation and/or cardiovascular disease. These include inflammatory proteins, cytokines, adipokines and other signaling proteins. Improved clearance of this group of difficult to remove molecules has the potential to lead to improved outcomes in dialysis patients by reducing the burden of cardiovascular disease, which now needs to be assessed in robust clinical trials.
Collapse
Affiliation(s)
- Martin J Wolley
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Colin A Hutchison
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia.,Department of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand
| |
Collapse
|
11
|
Schwab S, Bös D, Hundt F, Kleine CE, Strassburg CP, Woitas RP. β-Trace protein in hemodialysis - comparison of different therapy modalities and high flux dialyzers. Clin Chem Lab Med 2019; 56:265-267. [PMID: 29715180 DOI: 10.1515/cclm-2018-0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/28/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Sebastian Schwab
- Department of Internal Medicine I, Medical Clinic I - University of Bonn, Bonn, Germany, Phone: +49 228 287 11038, Fax: +49 228 287 11052.,Institute of Experimental Immunology, Rheinische-Friedrichs-Wilhelms University of Bonn, Bonn, Germany
| | - Dominik Bös
- Department of Nephrology, Medical Clinic I - University of Bonn, Bonn, Germany.,KfH, Renal Center, Bonn, Germany
| | - Felix Hundt
- Department of Nephrology, Medical Clinic I - University of Bonn, Bonn, Germany.,KfH, Renal Center, Bonn, Germany
| | - Carola Ellen Kleine
- KfH, Renal Center, Bonn, Germany.,University of California Irvine, Orange, CA, USA
| | | | - Rainer Peter Woitas
- Department of Nephrology, Medical Clinic I - University of Bonn, Bonn, Germany.,KfH, Renal Center, Bonn, Germany
| |
Collapse
|
12
|
Steubl D, Inker LA. How best to estimate glomerular filtration rate? Novel filtration markers and their application. Curr Opin Nephrol Hypertens 2019; 27:398-405. [PMID: 30063487 DOI: 10.1097/mnh.0000000000000444] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease is an increasing health burden. Estimating equations using serum concentrations of creatinine and cystatin C facilitate the assessment of kidney function as reflected in estimated glomerular filtration rate (eGFR). Reduced eGFR is associated with increased risk for numerous adverse outcomes and is an important aspect in many clinical situations. However, current equations are suboptimal in some clinical settings. The review focuses on approaches to improve the estimation of GFR and aims to familiarize the reader with the underlying methodological hypotheses how new markers could contribute to improve the overall performance of estimating equations. RECENT FINDINGS Low molecular weight proteins such as β-trace-protein and β-2-microglobulin, as well as newly discovered metabolites, show promise as new filtration markers, as they might be beneficial in populations in which creatinine or cystatin C are inaccurate. We propose that the combination of multiple novel markers, alone or in combination with creatinine, cystatin C or demographics, can potentially improve GFR estimation. For special populations such as dialysis patients, separate equations have been developed to estimate residual kidney function. SUMMARY Current GFR estimating equations are an essential part of routine clinical practice but have limitations. The use of multiple markers combined in a single equation appears to be the most promising approach. Future research is required to validate proposed equations in diverse populations.
Collapse
Affiliation(s)
- Dominik Steubl
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.,Abteilung für Nephrologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Enko D, Meinitzer A, Scharnagl H, Stojakovic T, Kleber ME, Delgado GE, Zelzer S, Drechsler C, Krämer BK, Wanner C, März W, Woitas RP. Prospective cohort studies of beta-trace protein and mortality in haemodialysis patients and patients undergoing coronary angiography. Nephrol Dial Transplant 2018; 33:1984-1991. [PMID: 29474602 DOI: 10.1093/ndt/gfy025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Beta-trace protein (BTP) is a low-molecular-weight glycoprotein, which may serve as an endogenous biomarker of kidney function and cardiovascular risk. Methods We examined cardiovascular and all-cause mortality according to BTP concentrations in 2962 individuals referred for coronary angiography from the Ludwigshafen Risk and Cardiovascular Health study and in 907 patients with Type 2 diabetes mellitus undergoing haemodialysis from the German Diabetes and Dialysis (4D) study. Results Haemodialysis patients had considerably higher median (interquartile range) BTP concentrations [6.00 (4.49-7.96) mg/L] and experienced a 4-fold increased mortality rate compared with coronary angiography patients [BTP concentration: 0.55 (0.44-0.67) mg/L]. After adjustment for age, sex, cardiovascular risk factors and creatinine, 4D patients in the highest quartile (>7.96 mg/L) had a 1.6-fold increased rate of all-cause mortality [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.19-2.20] compared with the lowest quartile (<4.49 mg/L) (P = 0.002) In patients undergoing coronary angiography, the adjusted HRs (95% CI) for all-cause and cardiovascular mortality were 1.23 (1.0-1.51) and 1.27 (0.99-1.63) in the highest (>0.67 mg/L) compared with the lowest (<0.44 mg/L) quartile (P = 0.043 and 0.062). In both cohorts, the BTP/creatinine ratio was a stronger predictor of all-cause and cardiovascular mortality compared with BTP. Conclusion BTP was associated with all-cause mortality independently of renal function in haemodialysis patients. The BTP/creatinine ratio was more predictive for all-cause and cardiovascular mortality in haemodialysis patients and individuals referred for angiography compared with BTP as single marker.
Collapse
Affiliation(s)
- Dietmar Enko
- Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Graciela E Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sieglinde Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Christiane Drechsler
- Division of Nephrology, University of Würzburg, University Hospital, Würzburg, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Wanner
- Division of Nephrology, University of Würzburg, University Hospital, Würzburg, Germany
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Synlab Academy, Synlab Holding Germany GmbH, Mannheim and Augsburg, Germany
| | - Rainer P Woitas
- Division of Nephrology, Department of Internal Medicine I, Medical University of Bonn, Bonn.,KfH Renal Center Bonn, Bonn, Germany
| |
Collapse
|
14
|
Wolley M, Jardine M, Hutchison CA. Exploring the Clinical Relevance of Providing Increased Removal of Large Middle Molecules. Clin J Am Soc Nephrol 2018; 13:805-814. [PMID: 29507008 PMCID: PMC5969479 DOI: 10.2215/cjn.10110917] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dialysis technologies have continued to advance over recent decades; however, these advancements have not always been met with improved patient outcomes. In part, the high morbidity and mortality associated with dialysis have been attributed to a group of uremic toxins, which are described as "difficult to remove." With a new generation of hemodialysis membranes now making meaningful clearance of these molecules possible, it is an apt time to review the clinical relevance of these middle molecules. Our review describes the developments in membrane technology that enable the removal of large middle molecules (molecular mass >15 kD) that is limited with high-flux dialysis membranes. Of the known 58 middle molecules, a literature search identified 27 that have molecular mass >15 kD. This group contains cytokines, adipokines, hormones, and other proteins. These molecules are implicated in chronic inflammation, atherosclerosis, structural heart disease, and secondary immunodeficiency in the literature. Single-center safety and efficacy studies have identified that use of these membranes in maintenance dialysis populations is associated with limited loss of albumin and increased clearance of large middle molecules. Larger, robustly conducted, multicenter studies are now evaluating these findings. After completion of these safety and efficacy studies, the perceived clinical benefits of providing clearance of large middle molecules must be assessed in rigorously conducted, randomized clinical studies.
Collapse
Affiliation(s)
- Martin Wolley
- Department of Renal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Meg Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital and University of Sydney, Sydney, New South Wales, Australia; and
| | - Colin A. Hutchison
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medicine, Hawke’s Bay District Health Board, Hastings, New Zealand
| |
Collapse
|
15
|
Rocco MV, Chapman A, Chertow GM, Cohen D, Chen J, Cutler JA, Diamond MJ, Freedman BI, Hawfield A, Judd E, Killeen AA, Kirchner K, Lewis CE, Pajewski NM, Wall BM, Yee J. Chronic Kidney Disease Classification in Systolic Blood Pressure Intervention Trial: Comparison Using Modification of Diet in Renal Disease and CKD-Epidemiology Collaboration Definitions. Am J Nephrol 2016; 44:130-40. [PMID: 27513312 DOI: 10.1159/000448722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interventional trials have used either the Modification of Diet in Renal Disease (MDRD) or chronic kidney disease (CKD)-Epidemiology Collaboration (CKD-EPI) equation for determination of estimated glomerular filtration rate (eGFR) to define whether participants have stages 3-5 CKD. The equation used to calculate eGFR may influence the number and characteristics of participants designated as having CKD. METHODS We examined the classification of CKD at baseline using both equations in the Systolic Blood Pressure Intervention Trial (SPRINT). eGFR was calculated at baseline using fasting serum creatinine values from a central laboratory. RESULTS Among 9,308 participants with baseline CKD classification using the 4-variable MDRD equation specified in the SPRINT protocol, 681 (7.3%) participants were reclassified to a less advanced CKD stage (higher eGFR) and 346 (3.7%) were reclassified to a more advanced CKD stage (lower eGFR) when the CKD-EPI equation was used to calculate eGFR. For eGFRs <90 ml/min/1.73 m2, participants <75 years were more likely to be reclassified to a less advanced CKD stage; this reclassification was more likely to occur in non-blacks rather than blacks. Participants aged ≥75 years were more likely to be reclassified to a more advanced than a less advanced CKD stage, regardless of baseline CKD stage. Reclassification of baseline CKD status (eGFR <60 ml/min/1.73 m2) occurred in 3% of participants. CONCLUSIONS Use of the MDRD equation led to a higher percentage of participants being classified as having CKD stages 3-4. Younger and non-black participants were more likely to be reclassified as not having CKD using the CKD-EPI equation.
Collapse
|
16
|
Foster MC, Coresh J, Hsu CY, Xie D, Levey AS, Nelson RG, Eckfeldt JH, Vasan RS, Kimmel PL, Schelling J, Simonson M, Sondheimer JH, Anderson AH, Akkina S, Feldman HI, Kusek JW, Ojo AO, Inker LA. Serum β-Trace Protein and β2-Microglobulin as Predictors of ESRD, Mortality, and Cardiovascular Disease in Adults With CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2016; 68:68-76. [PMID: 26948990 PMCID: PMC4921300 DOI: 10.1053/j.ajkd.2016.01.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/05/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Serum β-trace protein (BTP) and β2-microglobulin (B2M) are independently associated with end-stage renal disease (ESRD) and mortality in the general population and high-risk groups with diabetes or advanced chronic kidney disease (CKD). Less is known about their associations with outcomes and predictive ability in adults with moderate CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,613 adults from the CRIC (Chronic Renal Insufficiency Cohort) Study (45% women; mean age, 57.9 years; 41.0% non-Hispanic black; 51.9% with diabetes). PREDICTORS BTP and B2M levels with a reciprocal transformation to reflect their associations with filtration, creatinine-based estimated glomerular filtration rate (eGFRcr), measured GFR, and a 4-marker composite score combining BTP, B2M, creatinine, and cystatin C levels. Predictors were standardized as z scores for comparisons across filtration markers. OUTCOMES ESRD, all-cause mortality, and new-onset cardiovascular disease. RESULTS During a 6-year median follow-up, 755 (21%) participants developed ESRD, 653 died, and 292 developed new-onset cardiovascular disease. BTP, B2M, and the 4-marker composite score were independent predictors of ESRD and all-cause mortality, and B2M and the 4-marker composite score of cardiovascular events, after multivariable adjustment. These associations were stronger than those observed for eGFRcr (P vs eGFRcr≤0.02). The 4-marker composite score led to improvements in C statistic and 2.5-year risk reclassification beyond eGFRcr for all outcomes. LIMITATIONS Filtration markers measured at one time point; measured GFR available in subset of cohort. CONCLUSIONS BTP and B2M levels may contribute additional risk information beyond eGFRcr, and the use of multiple markers may improve risk prediction beyond this well-established marker of kidney function among persons with moderate CKD.
Collapse
Affiliation(s)
| | | | - Chi-Yuan Hsu
- University of California, San Francisco, San Francisco, CA
| | - Dawei Xie
- University of Pennsylvania, Philadelphia, PA
| | | | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | | | | | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Akinlolu O Ojo
- University of Michigan School of Medicine, Ann Arbor, MI
| | | |
Collapse
|
17
|
Roumelioti ME, Nolin T, Unruh ML, Argyropoulos C. Revisiting the Middle Molecule Hypothesis of Uremic Toxicity: A Systematic Review of Beta 2 Microglobulin Population Kinetics and Large Scale Modeling of Hemodialysis Trials In Silico. PLoS One 2016; 11:e0153157. [PMID: 27055286 PMCID: PMC4824495 DOI: 10.1371/journal.pone.0153157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/24/2016] [Indexed: 01/01/2023] Open
Abstract
Background Beta-2 Microglobulin (β2M) is a prototypical “middle molecule” uremic toxin that has been associated with a higher risk of death in hemodialysis patients. A quantitative description of the relative importance of factors determining β2M concentrations among patients with impaired kidney function is currently lacking. Methods Herein we undertook a systematic review of existing studies reporting patient level data concerning generation, elimination and distribution of β2M in order to develop a population model of β2M kinetics. We used this model and previously determined relationships between predialysis β2M concentration and survival, to simulate the population distribution of predialysis β2M and the associated relative risk (RR) of death in patients receiving conventional thrice-weekly hemodialysis with low flux (LF) and high flux (HF) dialyzers, short (SD) and long daily (LD) HF hemodialysis sessions and on-line hemodiafiltration at different levels of residual renal function (RRF). Results We identified 9 studies of 106 individuals and 156 evaluations of or more compartmental kinetic parameters of β2M. These studies used a variety of experimental methods to determine β2M kinetics ranging from isotopic dilution to profiling of intra/inter dialytic concentration changes. Most of the patients (74/106) were on dialysis with minimal RRF, thus facilitating the estimation of non-renal elimination kinetics of β2M. In large scale (N = 10000) simulations of individuals drawn from the population of β2M kinetic parameters, we found that, higher dialytic removal materially affects β2M exposures only when RRF (renal clearance of β2M) was below 2 ml/min. In patients initiating conventional HF hemodialysis, total loss of RRF was predicted to be associated with a RR of death of more than 20%. Hemodiafiltration and daily dialysis may decrease the high risk of death of anuric patients by 10% relative to conventional, thrice weekly HF dialysis. Only daily long sessions of hemodialysis consistently reduced mortality risk between 7–19% across the range of β2M generation rate. Conclusions Preservation of RRF should be considered one of the therapeutic goals of hemodialysis practice. Randomized controlled trials of novel dialysis modalities may require large sample sizes to detect an effect on clinical outcomes even if they enroll anuric patients. The developed population model for β2M may allow personalization of hemodialysis prescription and/or facilitate the design of such studies by identifying patients with higher β2M generation rate.
Collapse
Affiliation(s)
- Maria Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, NM, United States of America
| | - Thomas Nolin
- Department of Pharmacy and Therapeutics, and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, United States of America
| | - Mark L. Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, NM, United States of America
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, NM, United States of America
- * E-mail:
| |
Collapse
|
18
|
Shao B, de Boer I, Tang C, Mayer PS, Zelnick L, Afkarian M, Heinecke JW, Himmelfarb J. A Cluster of Proteins Implicated in Kidney Disease Is Increased in High-Density Lipoprotein Isolated from Hemodialysis Subjects. J Proteome Res 2015; 14:2792-806. [PMID: 26011469 DOI: 10.1021/acs.jproteome.5b00060] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) patients treated with hemodialysis. An important contributor might be a decline in the cardioprotective effects of high-density lipoprotein (HDL). One important factor affecting HDL's cardioprotective properties may involve the alterations of protein composition in HDL. In the current study, we used complementary proteomics approaches to detect and quantify relative levels of proteins in HDL isolated from control and ESRD subjects. Shotgun proteomics analysis of HDL isolated from 20 control and 40 ESRD subjects identified 63 proteins in HDL. Targeted quantitative proteomics by isotope-dilution selective reaction monitoring revealed that 22 proteins were significantly enriched and 6 proteins were significantly decreased in ESRD patients. Strikingly, six proteins implicated in renal disease, including B2M, CST3, and PTGDS, were markedly increased in HDL of uremic subjects. Moreover, several of these proteins (SAA1, apoC-III, PON1, etc.) have been associated with atherosclerosis. Our observations indicate that the HDL proteome is extensively remodeled in uremic subjects. Alterations of the protein cargo of HDL might impact HDL's proposed cardioprotective properties. Quantifying proteins in HDL may be useful in the assessment of cardiovascular risk in patients with ESRD and in assessing response to therapeutic interventions.
Collapse
Affiliation(s)
- Baohai Shao
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Ian de Boer
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Chongren Tang
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Philip S Mayer
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Leila Zelnick
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Maryam Afkarian
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Jay W Heinecke
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| | - Jonathan Himmelfarb
- †Diabetes and Obesity Center of Excellence and ‡Kidney Research Institute, Department of Medicine, University of Washington, 850 Republican Street, Seattle, Washington 98195, United States
| |
Collapse
|
19
|
Foster MC, Inker LA, Hsu CY, Eckfeldt JH, Levey AS, Pavkov ME, Myers BD, Bennett PH, Kimmel PL, Vasan RS, Coresh J, Nelson RG. Filtration markers as predictors of ESRD and mortality in Southwestern American Indians with type 2 diabetes. Am J Kidney Dis 2015; 66:75-83. [PMID: 25773485 DOI: 10.1053/j.ajkd.2015.01.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/08/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND A growing number of serum filtration markers are associated with mortality and end-stage renal disease (ESRD) in adults. Whether β-trace protein (BTP) and β2-microglobulin (B2M) are associated with these outcomes in adults with type 2 diabetes is not known. STUDY DESIGN Longitudinal cohort study. SETTING & PARTICIPANTS 250 Pima Indians with type 2 diabetes (69% women; mean age, 42 years; mean diabetes duration, 11 years). PREDICTORS Serum BTP, B2M, and glomerular filtration rate measured by iothalamate clearance (mGFR) or estimated using creatinine (eGFRcr) or cystatin C level (eGFRcys). OUTCOMES & MEASUREMENTS Incident ESRD and all-cause mortality through December 2013. HRs were reported per interquartile range decrease of the inverse of BTP and B2M (1/BTP and 1/B2M) using Cox regression. Improvement in risk prediction with the addition of BTP or B2M level to established markers (eGFRcys with mGFR or eGFRcr) was evaluated using C statistics, continuous net reclassification improvement, and relative integrated discrimination improvement (RIDI). RESULTS During a median follow-up of 14 years, 69 participants developed ESRD and 95 died. Both novel markers were associated with ESRD in multivariable models. BTP level remained statistically significant after further adjustment for mGFR (1/BTP, 1.53 [95% CI, 1.01-2.30]; 1/B2M, 1.54 [95% CI, 0.98-2.42]). B2M level was associated with mortality in multivariable models and after further adjustment for mGFR (HR, 2.12; 95% CI, 1.38-3.26). The addition of B2M level to established markers increased the C statistic for mortality but only weakly when assessed by either continuous net reclassification improvement or RIDI; none was improved for ESRD by the addition of these markers. LIMITATIONS Small sample size, single measurements of markers. CONCLUSIONS In Pima Indians with type 2 diabetes, BTP and, to a lesser extent, B2M levels were associated with ESRD. B2M level was associated with mortality after adjustment for traditional risk factors and established filtration markers. Further studies are warranted to confirm whether inclusion of B2M level in a multimarker approach leads to improved risk prediction for mortality in this population.
Collapse
Affiliation(s)
| | | | - Chi-Yuan Hsu
- University of California, San Francisco, San Francisco, CA
| | | | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Peter H Bennett
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
| | | |
Collapse
|
20
|
White CA, Ghazan-Shahi S, Adams MA. β-Trace protein: a marker of GFR and other biological pathways. Am J Kidney Dis 2014; 65:131-46. [PMID: 25446025 DOI: 10.1053/j.ajkd.2014.06.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/27/2014] [Indexed: 11/11/2022]
Abstract
β-Trace protein (BTP), also known as lipocalin prostaglandin D2 synthase (L-PGDS; encoded by the PTGDS gene), is a low-molecular-weight glycoprotein and an emerging novel marker of glomerular filtration rate. BTP is an important constituent of cerebral spinal fluid and is found in much lower concentrations in blood. Its serum origin and renal handling remain poorly understood. Unlike serum creatinine, BTP is not physiologically inert. It possesses both ligand-binding and enzymatic properties. BTP catalyzes the conversion of prostaglandin H2 (PGH2) to PGD2. PGD2 is an eicosanoid involved in a variety of important physiologic processes, including platelet aggregation, vasodilation, inflammation, adipogenesis, and bone remodeling. Several studies now have documented BTP's strong association with glomerular filtration rate, end-stage renal disease, cardiovascular disease, and death in a variety of different patient populations. This review provides an overview of the biochemistry, physiology and metabolism, biological functions, and measurement of BTP; summarizes the evidence for BTP as a marker of both kidney function and cardiovascular disease; and then considers the interplay between its biological properties, serum concentration, and patient outcomes.
Collapse
Affiliation(s)
- Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Canada.
| | - Sassan Ghazan-Shahi
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
| |
Collapse
|
21
|
Filler G, Kusserow C, Lopes L, Kobrzyński M. Beta-trace protein as a marker of GFR--history, indications, and future research. Clin Biochem 2014; 47:1188-94. [PMID: 24833359 DOI: 10.1016/j.clinbiochem.2014.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Recent findings suggest that beta-trace protein (BTP), a small molecular weight protein, is at least equal if not superior to serum creatinine as a marker of glomerular filtration rate (GFR), particularly since it is independent from height, gender, age, and muscle mass. The authors sought to summarize knowledge on BTP and its use as a marker of GFR using the most recent literature available. DESIGN AND METHODS The authors compiled key articles and all relevant recent literature on this topic. Physical and chemical features of the molecule are described, as well as factors that may affect its expression. The use of BTP in estimating GFR as a whole and in specific patient groups, including pregnant women, neonates and infants, children and adolescents, and patients who have undergone renal transplantation is discussed. The use of BTP as a marker for cardiovascular risk factors is also briefly addressed. RESULTS Although its performance in the general population is marginally inferior to cystatin C, studies have suggested that it may be superior in accurately estimating GFR in select patient groups such as pregnant women and neonates. CONCLUSIONS This novel marker shows promise, but further research is required to clarify findings from available data.
Collapse
Affiliation(s)
- Guido Filler
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N5A 5A5, Canada; Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N5A 5A5, Canada.
| | - Carola Kusserow
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada
| | - Laudelino Lopes
- Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada
| | - Marta Kobrzyński
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada
| |
Collapse
|
22
|
Foster MC, Inker LA, Levey AS, Selvin E, Eckfeldt J, Juraschek SP, Coresh J. Novel filtration markers as predictors of all-cause and cardiovascular mortality in US adults. Am J Kidney Dis 2013; 62:42-51. [PMID: 23518194 DOI: 10.1053/j.ajkd.2013.01.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/14/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND New filtration markers, including β-trace protein (BTP) and β₂-microglobulin (B2M), may, similar to cystatin C, enable a stronger prediction of mortality compared to serum creatinine-based estimated glomerular filtration rate (eGFRcr). We sought to evaluate these mortality associations in a representative sample of US adults. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 6,445 adults 20 years or older from the Third National Health and Nutrition Examination Survey (1988-1994) with mortality linkage through December 31, 2006. PREDICTORS Serum cystatin C, BTP, and B2M levels and eGFRcr categorized into quintiles, with the highest quintile (lowest for eGFRcr) split into tertiles (subquintiles Q5a-Q5c). OUTCOMES All-cause, cardiovascular disease, and coronary heart disease mortality. MEASUREMENTS Demographic- and multivariable-adjusted Cox proportional hazard models. RESULTS During follow-up, 2,392 deaths (cardiovascular, 1,079; coronary heart disease, 605) occurred. Levels of all 4 filtration markers were associated with mortality risk after adjusting for demographics (P trend<0.02). Adjusted for mortality risk factors, compared to the middle quintile, the highest subquintiles for cystatin C (Q5c: HR, 1.94; 95% CI, 1.43-2.62), BTP (Q5c: HR, 2.14; 95% CI, 1.56-2.94), and B2M (Q5c: HR, 2.58; 95% CI, 1.96-3.41) were associated with increased all-cause mortality risk, whereas the association was weaker for eGFRcr (Q5c: HR, 1.31; 95% CI, 0.84-2.04). Associations persisted for the novel markers and not for eGFRcr at eGFRcr ≥60 mL/min/1.73 m². Trends were similar for cardiovascular disease and coronary heart disease mortality. LIMITATIONS Single measurements of markers from long-term stored samples. CONCLUSIONS The strong association of cystatin C level with mortality compared with serum creatinine estimates is shared by BTP and B2M. This supports the utility of alternative filtration markers beyond creatinine when improved risk prediction related to decreased GFR is needed.
Collapse
Affiliation(s)
- Meredith C Foster
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Orenes-Piñero E, Manzano-Fernández S, López-Cuenca Á, Marín F, Valdés M, Januzzi JL. β-Trace Protein: From GFR Marker to Cardiovascular Risk Predictor. Clin J Am Soc Nephrol 2013; 8:873-81. [DOI: 10.2215/cjn.08870812] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|