Alkaline phosphatase is independently associated with renal function in normoalbuminuric type 1 diabetic patients

Abstract

Nonalcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of chronic kidney disease in patients with type 1 diabetes. The aim of this study was to explore the relationship between markers of NAFLD, namely concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK), g-glutamyltransferase (GGT), bilirubin, and renal function in type 1 diabetic patients. This study included 313 normoalbuminuric type 1 diabetic patients with estimated glomerular filtration rate (eGFR) 460 mL/min/1.73 m 2 , without clinical evidence of cirrhosis or other causes of chronic liver disease and before any interventions with statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers. ALT, GGT, and bilirubin levels were significantly higher in subjects in the highest quartile of serum creatinine compared to those in lowest quartile (21 vs. 20 U/L, 18 vs. 14 U/L, and 14 vs. 10 mmol/L, respectively, for all p50.05). ALK levels were significantly higher in subjects in the highest quartile of urinary albumin excretion rate compared to those in lowest quartile (71 vs. 69 U/L, p ¼ 0.03), as well as in hyperfiltrating subjects compared to those with normal or mildly impaired eGFR (81 vs. 68 and 64 U/L, p50.001). In a multiple logistic regression model adjusted for age, sex, duration of diabetes, HbA1c, and body mass index (BMI), only ALK levels were significantly associated with disturbances in serum creatinine and eGFR in our subjects (p 0.007), with odds ratios of 0.98-1.02. NAFLD associated markers, particularly ALK, are associated with renal function in normoalbuminuric type 1 diabetic patients.

Non-Alcoholic Steatohepatitis: Clinical and Translational Research

“…The clinical aspects of NASH, as part of MS, can be monitored by non-invasive biomarkers. Markers of NAFLD such as ALT, γ-GTP and bilirubin were elevated among individuals with higher serum creatinine levels in a sample of 313 normo-albuminuric type 1 diabetic patients with eGFR >60 mL/min/1.73m 2 , while alkaline phosphatase levels were higher in subjects with elevated urinary albumin excretion rate (76). Serum acid uric levels were associated with NAFLD and MS in patients with normal kidney function in a cross-sectional study performed on 1141 middleaged and elderly participants.…”

Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD

“…In patients with type 1 diabetes mellitus (T1DM), an increase in circulating levels of ALP is associated with glomerular hyperfiltration, proteinuria and CKD progression in the early stages of diabetic nephropathy 122,123 . These studies did not characterize the origin of the increased levels of serum ALP.…”

Progression of Albuminuria Among Patients with Type 1 Diabetes Mellitus: A Long Term Observational Follow-up Study

“…In our study, decreases in serum alkaline phosphatase levels were recorded, too. Alkaline phosphatase levels have been suggested to be independently associated with renal function in normoalbuminuric type 1 diabetic patients [33]. Increased levels of alkaline phosphatase, may be found in autoimmune diseases and DM1 is certainly one of them [34].…”