Associations of Serum Skeletal Alkaline Phosphatase with Elevated C-Reactive Protein and Mortality

Filipowicz, Rebecca; Greene, Tom; Wei, Guo; Cheung, Alfred K.; Raphael, Kalani L.; Baird, Bradley C.; Beddhu, Srinivasan

doi:10.2215/cjn.12031111

Cited by 39 publications

(33 citation statements)

References 20 publications

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“…Therefore, most large retrospective, observational studies such as this use ALP since it is inexpensive and frequently measured. Further, a recent analysis using NHANES data did not show an association between bALP and mortality in a non-dialysis-dependent CKD population 23 .…”

Section: Discussionmentioning

confidence: 81%

Prognostic Importance of Serum Alkaline Phosphatase in CKD Stages 3-4 in a Clinical Population

Taliercio

Schold

Simon

et al. 2013

American Journal of Kidney Diseases

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Background Elevated total serum alkaline phosphatase (ALP) levels have been associated with mortality in the general population and in dialysis patients. Study Design Retrospective cohort study. Setting & Participants 28,678 patients with chronic kidney disease (CKD) stages 3 and 4 (estimated glomerular filtration rate [eGFR], 15–59 ml/min/1.73 m2) were identified using the Cleveland Clinic Chronic Kidney Disease Registry. CKD was defined as two eGFR values <60 ml/min/1.73 m2 drawn >90 days apart using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Predictor ALP levels measured using the calorimetric assay was examined as quartiles (quartile 1, <66 U/L; Q2, 66–81 U/L; Q3, 82–101 U/L; and Q4, ≥102 U/L) and as a continuous measure. Outcomes & Measurements All-cause mortality and ESRD were ascertained using the Social Security Death Index and US Renal Data System. Results After a median follow up of 2.2 years, 588 patients progressed to ESRD and 4,755 died. There was a graded increase in the risk for mortality with higher ALP quartiles (Q2, Q3, Q4) when compared to the reference quartile (Q1) after adjusting for demographics, comorbid conditions, use of relevant medications and liver function tests. The highest quartile of ALP was associated with a hazard ratio for ESRD of 1.38 (95% CI, 1.09–1.76). Each 1-standard deviation (42.7 U/L) higher ALP level was associated with 15% (95% CI, 1.09–1.22) and 16% (95% CI, 1.14–1.18) increased risk of ESRD and mortality respectively. Limitations Single center observational study, lack complete data including PTH for all study participants and attrition bias. Conclusions Higher serum ALP levels in CKD stages 3–4 were independently associated with all-cause mortality and ESRD.

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Section: Discussionmentioning

confidence: 81%

Prognostic Importance of Serum Alkaline Phosphatase in CKD Stages 3-4 in a Clinical Population

Taliercio

Schold

Simon

et al. 2013

American Journal of Kidney Diseases

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“…However, few studies have shown that bone-specific ALP is a better predictor of death than total ALP in HD patients (25). A recent analysis using NHANES data did not show an association between bone-specific ALP level and mortality in the nondialysis-dependent CKD population (26). In addition, bone-specific ALP is not measured routinely, because the assay is not readily available and is expensive.…”

Section: Discussionmentioning

confidence: 99%

Alkaline Phosphatase and Mortality in Patients on Peritoneal Dialysis

Liu

Guo

Feng

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Elevated total serum alkaline phosphatase levels have been associated with higher mortality in the general population, CKD patients, and hemodialysis patients. However, in peritoneal dialysis patients, this association has received little attention. The aim of this study was to evaluate the association between alkaline phosphatase and all-cause and cardiovascular mortality in peritoneal dialysis patients.Design, setting, participants, & measurements In this single center retrospective cohort study, 1021 incident peritoneal dialysis patients from January 1, 2006, to December 31, 2010 with baseline serum alkaline phosphatase values were enrolled. Collected baseline data included demographic characteristics and clinical and laboratory measurements. All patients were followed until December 31, 2012. The associations of total serum alkaline phosphatase levels with allcause and cardiovascular mortality were assessed using multivariable-adjusted Cox models.Results Of 1021 patients, mean age was 47.5 (615.5) years, 59.1% of patients were men, and 22.8% of patients were diabetic. The median serum alkaline phosphatase level was 64 U/L (interquartile range=52-82 U/L). During a median 31-month (interquartile range=19-45 months) follow-up period, 203 patients died, of which 109 deaths were caused by cardiovascular disease. After adjusting for demographics, comorbid conditions, liver function, and bone metabolism parameters, the highest alkaline phosphatase quartile was significantly associated with a hazard ratio for all-cause mortality of 1.70 (95% confidence interval, 1.06 to 2.74, P=0.03) and a hazard ratio for cardiovascular mortality of 1.94 (95% confidence interval, 1.02 to 3.72, P=0.04). Each 10 U/L higher baseline alkaline phosphatase level was associated with 4% (95% confidence interval, 1.00 to 1.08, P=0.04) and 7% (95% confidence interval, 1.02 to 1.11, P=0.003) higher risk of all-cause and cardiovascular mortality, respectively. ConclusionHigher total serum alkaline phosphatase levels at the commencement of peritoneal dialysis were independently associated with all-cause and cardiovascular mortality in peritoneal dialysis patients.

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“…In clinical setting, ALP has been mostly used as a laboratory test for hepatobiliary (obstructive) and bone disease. Population-based studies have suggested an association between elevated ALP activity and cardiovascular disease (CVD) or mortality [3][4][5][6]. Limited evidence suggests an association between ALP and the risk of mortality in patients with prior myocardial infarction, [4] stroke [7] or after coronary stenting [8].…”

Section: Introductionmentioning

confidence: 99%