The effect of increased frequency of hemodialysis on serum cystatin C and β2-microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial

the Frequent Hemodialysis Network (FHN) Group

Research output: Contribution to journalArticle

Abstract

Introduction: Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta-2 microglobulin (β2-M) are understudied. We hypothesized that lowering of predialysis CysC and β2-M serum concentrations would be affected by switching to more frequent hemodialysis. Methods: Predialysis CysC and β2-M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12-months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2-M concentrations and outcomes. Findings: Forty-nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2-M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (−3.8 ± 12.62 μg/mL, P = 0.004; −5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12-months predialysis β2-M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12-months and in changes in left ventricular mass, physical-health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. Discussion: β2-M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long-lived proteins of the size of β-2M is one potential long-term benefit of more intensive dialysis that may be explored.

Original languageEnglish (US)
JournalHemodialysis International
DOIs
StatePublished - Jan 1 2019

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Salivary Cystatins
Cystatin C
Renal Dialysis
Serum
Dialysis
Hospitalization
Biomarkers
beta 2-Microglobulin
Poisons
Molecular Weight
Kidney
Control Groups
Mortality

Keywords

  • cystatin C
  • hemodialysis
  • hemodialysis adequacy
  • urea modeling
  • β2-microglobulin

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

@article{94f5342e84fc46c69e3fcff900b744b7,
title = "The effect of increased frequency of hemodialysis on serum cystatin C and β2-microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial",
abstract = "Introduction: Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta-2 microglobulin (β2-M) are understudied. We hypothesized that lowering of predialysis CysC and β2-M serum concentrations would be affected by switching to more frequent hemodialysis. Methods: Predialysis CysC and β2-M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12-months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2-M concentrations and outcomes. Findings: Forty-nine percent and 52{\%} of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2-M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (−3.8 ± 12.62 μg/mL, P = 0.004; −5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12-months predialysis β2-M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12-months and in changes in left ventricular mass, physical-health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. Discussion: β2-M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long-lived proteins of the size of β-2M is one potential long-term benefit of more intensive dialysis that may be explored.",
keywords = "cystatin C, hemodialysis, hemodialysis adequacy, urea modeling, β2-microglobulin",
author = "{the Frequent Hemodialysis Network (FHN) Group} and Huang, {Shih Han S.} and George Kaysen and Levin, {Nathan W.} and Kliger, {Alan S.} and Beck, {Gerald J.} and Rocco, {Michael V.} and Guido Filler and Lindsay, {Robert M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/hdi.12749",
language = "English (US)",
journal = "Hemodialysis International",
issn = "1492-7535",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - The effect of increased frequency of hemodialysis on serum cystatin C and β2-microglobulin concentrations

T2 - A secondary analysis of the frequent hemodialysis network (FHN) trial

AU - the Frequent Hemodialysis Network (FHN) Group

AU - Huang, Shih Han S.

AU - Kaysen, George

AU - Levin, Nathan W.

AU - Kliger, Alan S.

AU - Beck, Gerald J.

AU - Rocco, Michael V.

AU - Filler, Guido

AU - Lindsay, Robert M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta-2 microglobulin (β2-M) are understudied. We hypothesized that lowering of predialysis CysC and β2-M serum concentrations would be affected by switching to more frequent hemodialysis. Methods: Predialysis CysC and β2-M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12-months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2-M concentrations and outcomes. Findings: Forty-nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2-M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (−3.8 ± 12.62 μg/mL, P = 0.004; −5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12-months predialysis β2-M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12-months and in changes in left ventricular mass, physical-health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. Discussion: β2-M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long-lived proteins of the size of β-2M is one potential long-term benefit of more intensive dialysis that may be explored.

AB - Introduction: Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta-2 microglobulin (β2-M) are understudied. We hypothesized that lowering of predialysis CysC and β2-M serum concentrations would be affected by switching to more frequent hemodialysis. Methods: Predialysis CysC and β2-M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12-months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2-M concentrations and outcomes. Findings: Forty-nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2-M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (−3.8 ± 12.62 μg/mL, P = 0.004; −5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12-months predialysis β2-M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12-months and in changes in left ventricular mass, physical-health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. Discussion: β2-M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long-lived proteins of the size of β-2M is one potential long-term benefit of more intensive dialysis that may be explored.

KW - cystatin C

KW - hemodialysis

KW - hemodialysis adequacy

KW - urea modeling

KW - β2-microglobulin

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U2 - 10.1111/hdi.12749

DO - 10.1111/hdi.12749

M3 - Article

AN - SCOPUS:85063011264

JO - Hemodialysis International

JF - Hemodialysis International

SN - 1492-7535

ER -