Strong Correlation of B2-Microglobulin (B2-m) with Procalcitonin (PCT) in the Serum of Chronic Hemodialysis Patients: A Role for Infections in the Dialysis-Related Amyloidosis?

Introduction. Infections trigger the activation of defensive cells capable to produce and release B2-microglobulin (B2-m). Procalcitonin (PCT), secreted by a wide range of human cells, included the aforementioned defensive cells, is generally considered a sensitive and specific marker of infection. In this prospective study, we examined the possibility that infections, as detected by increased levels of PCT, increase the serum levels of B2-m in chronic hemodialysis (CHD) patients, possibly affecting the rate of progression of dialysis-related amyloidosis (DRA). Methods. For a period of four months, 76 CHD patients, 45 men 31 women, mean age 63 ± 15.7 years, with no residual renal function and in HD for 46 ± 50 months were studied bimonthly. Blood was drawn, at baseline T(0), two months T(2), and four months T(4), for measuring hematocrit (Ht), white blood cells (WBC), erythrocyte sedimentation rate (ESR), blood urea and serum creatinine, protein (albumin, globulin), C-reactive protein (CRP), and PCT και B2-m. Any events (especially infections) in the preceding 10-day period were recorded. Results. At baseline, 100% of all B2-m measurements were abnormal (>2.4 mg L), 13.4% of PCT values were increased (>1.5 ng mL), and 49.4% of CRP values exceeded the lower limit of 5 mg L with no statistically significant differences between the results of the three periods of the study. Statistically significant, in all periods, was the linear positive correlation of B2-m with PCT (T[0]: p < 0.001, T[2]: p < 0.004, T[4]: p < 0.001). Also, statistically significant (p < 0.005) was the positive correlation of B2-m to HD vintage. Conclusions. In this study, the strong positive correlation of B2-m to PCT probably signifies that the (mainly subclinical) infections increase B2-m production in CHD patients intensifying the problem of HD-related amyloidosis.