Abstract
Background and Aims
Serum β M is a middle molecule uremic toxin that accumulates in serum and deposits at various tissues in chronic kidney disease (CKD), especially more in dialysis patients. The βâ M is generally considered as a predictor of cardiovascular morbidity and mortality and this is more investigated in dialysis group. However its relationship with several cardiac and metabolic risk factors in all stages of CKD is still under evaluation.
This study was undertaken to evaluate the association of plasma βâ M level in different stages of chronic kidney disease patients with different cardiac, renal and metabolic risk factors that can predict future cardiovascular events
Method
This cross-sectional study was conducted by selecting consecutive 132 CKD subjects of stages 1-5D including both patients not requiring dialysis and those on maintenance hemodialysis. Their demographic, clinical and laboratory data were recorded in a data sheet. Fasting blood samples in dialysis non requiring subjects and predialysis samples in hemodialysis group (G5D) were taken for testin in laboratory for CBC, serum βâ M, hCRP, iPTH, lipid profile, creatinine, uric acid and serum albumin as cardiac, renal and metabolic risk markers. Urine sample was taken from predialysis patients for chemical test and ACR. The CKD staging were done by MDRD criteria. Additional 25 no CKD subject was taken as healthy referents.
Results
Primarily Beta-2 microglobulin was higher in CKD patients than in healthy group (13.53 ± 14.74 vs. 1.81 ± 0.47, mg/l; p<.001). The levels were gradually rising with the advancing stages of CKD (G1&2-3.46 ± 2.39, G3-3.66 ± 1.08, G4-6.51 ± 2.20, G5-11.43 ± 2.98 and G5D-41.79 ± 8.58, mg/l). A Beta-2 microglobulin cut-off of >7.7 vs. < 7.7 mg/l showed significantly increased Systolic BP (136 ±22 vs. 123 ± 22, mmHg), diastolic BP (80 ± 12 vs. 75 ± 8.96, mmHg),( p<0.01); CRP (6.83 ± 6.03 vs. 4.39 ± 5.35, mg/l)( p<0.007); serum phosphate (4.84 ± 1.79 vs. 3.85 ±.92,mg/dl)( p<0.001); uric acid (5.89 ± 1.41 vs. 5.01 ± 1.57,mg/dl)( p<0.01); TG (189± 103 vs. 155 ± 88, mg/dl),( p<0.04); and PTH (239.83 ± 186.50 vs. 90.52 ± 81.77, pg/ml), ( p<0.001) indicating higher cardio metabolic risks in higher group. Similarly renal parameters were also more altered in high Beta-2 microalbumin group for serum creatinine (6.89 ± 3.54 vs. 1.58 ± .81, mg/dl) (p<0.001) and ACR (824 ± 917 vs. 320 ± 753, mg/g),( p<0.001). B-2 microglobulin also positively correlated with systolic blood pressure (r=.295, p<.001), serum creatinine (r=.879, p<.001), serum phosphate (r=.175, p =.047), serum iPTH (r=.403, p<.001) , hCRP ( r=.193, p =.050) , Triglycerides (r=.196, p =.023) and urine ACR in CKD patients.
Conclusion
Beta-2 microglobulin level was significantly higher in CKD with an increasing pattern towards advancing stages. The higher levels positively correlated with cardio renal and metabolic risk factors. Hence measuring Beta-2 microglobulin regularly can help to take preventive measures early to manage patients at risk.
PENGARUH EKSTRAK ETANOL DAUN KEMANGI (Ocimum bacilicum L.) TERHADAP KADAR β2 MIKROGLOBULIN, ASAM URAT DAN GAMBARAN HISTOLOGI GINJAL PADA TIKUS PUTIH GALUR WISTAR (Rattus novergicus strain Wistar) YANG DIINDUKSI MONOSODIUM GLUTAMAT