Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients

Abstract

BackgroundSerum alkaline phosphatase (ALP) levels have been reported to be associated with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. However, it is unclear whether serum ALP levels predict infection-related clinical outcomes in PD patients. The aim of this study was to determine the relationships between serum ALP levels, infection-related mortality and hospitalization in PD patients.MethodsPD patients from the Clinical Research Center registry for end-stage renal disease, a multicenter prospective observational cohort study in Korea, were included in the present study. Patients were categorized into three groups by serum ALP tertiles as follows: Tertile 1, ALP <78 U/L; Tertile 2, ALP = 78–155 U/L; Tertile 3, ALP >155 U/L. Tertile 1 was used as the reference category. The primary outcomes were infection-related mortality and hospitalization.ResultsA total of 1,455 PD patients were included. The median follow-up period was 32 months. The most common cause of infection-related mortality and hospitalization was PD-related peritonitis. Multivariate Cox regression analyses showed that patients in the highest tertiles of serum ALP levels were at higher risk of infection-related mortality (HR 2.29, 95% CI, 1.42–5.21, P = 0.008) after adjustment for clinical variables. Higher tertiles of serum ALP levels were associated with higher risk of infection-related hospitalization (Tertile 2: HR 1.56, 95% CI, 1.18–2.19, P = 0.009, tertile 3: HR 1.34, 95% CI, 1.03–2.62, P = 0.031).ConclusionsOur data showed that elevated serum ALP levels were independently associated with a higher risk of infection-related mortality and hospitalization in PD patients.

Prognostic impact of preoperative serum alkaline phosphatase level on a composite of morbidity and mortality after thoracic endovascular aortic repair

“…A renoprotective action of ALP through reduced inflammation and oxidative stress was reported, [3,6,29] whereas a strong association was found between higher ALP level and poor prognosis in patients with kidney disease. [9,10,20,26] Our analysis revealing a biphasic relationship between the ALP tertiles and dialysis requirement, despite the lack of statistical significance, may be explained in this context.…”

“…[5] Accordingly, increased serum ALP level is considered a cellular response to inflammatory stimuli such as bacterial invasion. [3] In this regard, there are several reports on the association of higher serum ALP level and infection-related death both in patients undergoing dialysis [26] and in those with normal renal function. [27] Our finding of a close relationship between ALP level and the composite of endpoints could also be at least partly attributable to infection and sepsis-related mortality, although there was no significant association of ALP level and infection per se.…”

Low parathyroid hormone level predicts infection-related mortality in incident dialysis patients: a prospective cohort study

“…An observational study, the Dialysis Outcomes and Practice Patterns Study (DOPPS), found that elevated serum ALP level was associated with higher risk of infection-related death in HD patients, independent of calcium, phosphorus, and iPTH levels [25]. Two recent multicenter prospective studies in Korea also showed that elevated serum ALP level and low serum phosphorus level were independently associated with higher risk of infection-related mortality in dialysis patients [32,33]. To the best of our knowledge, the present study is the first multicenter prospective study showing significant associations between serum iPTH level and mortality risk of infection, rather than cardiovascular disease, in incident dialysis patients.…”

Parathyroid hormone and premature thymus ageing in patients with chronic kidney disease

“…In patients with CKD, mineral and bone disease (MBD) can cause abnormal serum concentration of calcium, phosphorus, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and alkaline phosphatase (ALP), resulting in bone-related abnormalities and vascular calcification. This complication is associated with increased mortality by CVD or infectious disease 6–14 .…”