Elevated serum alkaline phosphatase and cardiovascular or all-cause mortality risk in dialysis patients: A meta-analysis

Abstract

Studies on serum alkaline phosphatase (ALP) and mortality risk in patients with end-stage renal disease (ESRD) undergoing dialysis have yielded conflicting results. This meta-analysis was designed to assess the association of serum ALP levels with cardiovascular or all-cause mortality risk among patients on dialysis. PubMed and Embase databases were searched until March 2017 for studies evaluating the association of serum ALP levels and cardiovascular or all-cause mortality risk in adult patients with ESRD undergoing maintenance hemodialysis or chronic peritoneal dialysis. Twelve studies enrolling 393,200 patients on dialysis were included. Compared with the reference low serum ALP category, pooled adjusted hazard risk (HR) of all-cause mortality was 1.46 (95% confidence interval [CI] 1.30–1.65) for patients on hemodialysis and 1.93 (95% CI 1.71–2.17) for peritoneal patients on dialysis. In addition, elevated serum ALP significantly increased cardiovascular mortality among patients on peritoneal dialysis (HR 2.39; 95% CI 1.23–4.65) but not in patients on hemodialysis (HR 1.08; 95% CI 0.84–1.40). Elevated serum ALP was an independent risk factor for all-cause mortality among patients on hemodialysis or peritoneal dialysis. Further well-designed prospective studies are needed to investigate the association of high serum ALP levels with cardiovascular mortality among patients on dialysis.

Prognostic value of serum alkaline phosphatase in the survival of prostate cancer: evidence from a meta-analysis

“…Serum ALP level is a widely used parameter for liver disease, bone disease burden, and treatment effects 10. It is acknowledged that the elevation in ALP level is positively related to the rise of bone activity like osteosarcoma 11.…”

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.…”

“…[22] In this context, higher serum ALP levels have been implicated in the poor prognosis of patients with kidney failure whose mineral metabolism is altered. [9,10] The associations of serum ALP levels with mortality were also demonstrated in other patient cohorts, including those with previous MI or stroke, elderly patients, and even in the general population. [11–15] Along with such a strong predictability for the natural course and survival of patients with vascular diseases, serum ALP level was recently shown to have a prognostic potential for post-interventional adverse events in patients with CAOD undergoing percutaneous revascularization.…”

“…[3,5–7] Accordingly, the activity of TNALP has been reported to regulate the atherosclerotic process. [8] Serum ALP level mainly reflects TNALP [5] and shows a strong predictability for poor mid-term and long-term prognosis in patients with kidney disease, [9,10] old age, [11] myocardial infarction (MI), [12] and stroke, [13,14] as well as in the general population. [15] In patients undergoing percutaneous coronary intervention (PCI), elevated serum ALP level is closely associated with a higher risk of adverse cardiac and cerebrovascular events, [16] or mortality and stent thrombosis.…”

Novel Approaches for Assessment of Bone Turnover in CKD: Is New Always Better?

“…Elevated tAP was shown to be associated with higher rates of fractures and all-cause mortality in CKD. 2,3 On the basis of the authors' findings, a single tAP measurement could allow one to initiate a global bone turnover assessment before addressing the levels of less readily available BTMs, such as bone alkaline phosphatase, intact procollagen type 1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b. Although it is clearly important to continue advancing noninvasive diagnostic methods for clinical evaluation of bone turnover in CKD, it is also important to continue acknowledging that "older" approaches evaluating the bone turnover can provide information that at least has similar clinical meaning at a lesser cost.…”