Filtration markers as predictors of ESRD and mortality in southwestern American Indians with type 2 diabetes

Meredith C. Foster, Lesley A. Inker, Chi Yuan Hsu, John H. Eckfeldt, Andrew S. Levey, Meda E. Pavkov, Bryan D. Myers, Peter H. Bennett, Paul L. Kimmel, Ramachandran S. Vasan, Josef Coresh, Robert G. Nelson

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21 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)75-83
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume66
Issue number1
DOIs
StatePublished - Jul 1 2015

Keywords

  • Beta-trace protein (BTP)
  • CKD Biomarkers Consortium
  • Pima Indians
  • beta-2 microglobulin (B2M)
  • diabetic kidney failure
  • end-stage renal disease (ESRD)
  • filtration markers
  • glomerular filtration rate (GFR)
  • kidney function
  • mortality
  • type 2 diabetes mellitus

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    Foster, M. C., Inker, L. A., Hsu, C. Y., Eckfeldt, J. H., Levey, A. S., Pavkov, M. E., Myers, B. D., Bennett, P. H., Kimmel, P. L., Vasan, R. S., Coresh, J., & Nelson, R. G. (2015). Filtration markers as predictors of ESRD and mortality in southwestern American Indians with type 2 diabetes. American Journal of Kidney Diseases, 66(1), 75-83. https://doi.org/10.1053/j.ajkd.2015.01.013