Association between serum alkaline phosphatase and renal outcome in patients with type 2 diabetes mellitus

Abstract

This retrospective study included 299 patients with type 2 diabetes mellitus and biopsy-confirmed diabetic nephropathy (DN) to investigate the prognostic value of alkaline phosphatase (ALP) for renal outcome. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for the serum ALP level on renal outcome, which was defined as end-stage renal disease (ESRD) or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline. The median baseline ALP was 80 IU/L with an interquartile range of 64-97 IU/L. Serum ALP was negatively associated with eGFR but positively associated with proteinuria and renal interstitial fibrosis. During a median follow-up period of 23 months, ESRD or a 50% declined in the eGFR occurred in 156 (52.2%) patients. The highest quartile of ALP was significantly associated with poor renal outcome, as defined above (HR 2.38, 95% confidence interval [CI] 1.09-5.17), when adjusted for sociodemographics, baseline eGFR, proteinuria, liver function parameters, parathyroid hormone levels, and renal pathological findings. Each standard deviation higher in the natural log-transformed ALP was associated with a 25% increased risk for poor renal outcome. Additionally, there was a graded increase in the risk for poor renal outcome with higher ALP in patients with nephrotic-range proteinuria. However, no significant associations were observed between serum ALP levels and renal outcome in patients with non-nephrotic-range proteinuria. In conclusion, an elevated ALP level was independently associated with poor renal outcome in patients with type 2 diabetes mellitus and nephrotic-range proteinuria after multivariate adjustment.

Urinary complement proteins and risk of end-stage renal disease: quantitative urinary proteomics in patients with type 2 diabetes and biopsy-proven diabetic nephropathy

“…Laboratory data at the time of renal biopsy were also obtained from medical records, including hemoglobin, serum creatinine, 24-h proteinuria, and urine albumin-to-creatinine ratio. eGFR was evaluated using the CKD Epidemiology Collaboration formula [ 21 , 22 ]. Serum creatinine concentration was measured using the Cobas c702 chemistry autoanalyzer by enzymatic creatinine method (Roche Diagnostics, Rotkreuz, Switzerland).…”

Association between atherosclerotic cardiovascular diseases risk and renal outcome in patients with type 2 diabetes mellitus

“…Diabetes mellitus (DM) has become a pandemic throughout these decades. As reported by the International Diabetes Federation (IDF) in 2019, the number of people with DM was estimated to be 463 million and was thought to reach 700 million by 2045 [ 1 ], with most having type 2 diabetes mellitus (T2DM). Cardiovascular disease (CVD), one of the principal macrovascular complications of diabetes, causes 40–60% of deaths inpatients with T2DM [ 2 ].…”

Burden of chronic kidney disease and rapid decline in renal function among adults attending a hospital-based diabetes center in Northern Europe

“… 50 In patients with biopsy-confirmed DKD and nephrotic-range proteinuria, elevated serum ALP levels are independently associated with poorer renal outcomes (ESRD or 50% decline in eGFR from baseline). 51 In patients without diabetes with newly diagnosed untreated hypertension, ALP is associated with a reduction in eGFR, potentially mediated through low-grade inflammation, endothelial dysfunction, vascular calcification and modulation of BP. 52 ALP may increase in response to low levels of active vitamin D that occur as renal function declines.…”