Serum alkaline phosphatase levels correlate with long-term mortality solely in peritoneal dialysis patients with residual renal function

Abstract

Introduction: Increased serum alkaline phosphatase (ALP) is predictive of a higher mortality in patients with end-stage renal disease. However, it remains unknown whether residual renal function (RRF) influences the outcome-association of serum ALP among peritoneal dialysis (PD) patients. Methods: A total of 650 incident PD patients receiving PD catheter implantation in an institute between 1 November 2005 and 28 February 2017 were retrospectively enrolled. These patients were divided into groups with and without RRF (RRF and non-RRF groups) and those with serum ALP levels in tertiles. The Kaplan–Meier method and multivariate Cox proportional hazard models were used to analyze their outcomes based on RRF and serum ALP levels. Results: These 650 patients had a mean age of 49.4 ± 14.0 years old, their median ALP level was 74 U/L (interquartile range (IQR): 59–98). After 28-month (IQR: 14–41) follow-up, 80 patients in RRF group and 40 patients in non-RRF group died. PD patients with the highest serum ALP tertile had significant lower survival ( p = .014), when compared to other patients in the RRF group. However, this relationship was not observed in patients in the non-RRF group. After multivariate adjustment, in the RRF group, patients with the highest ALP tertile had a significantly higher risk of mortality (hazard ratio (HR): 2.26, 95% confidence interval (CI): 1.06–4.82, p = .034). Each 10-U/L increase in ALP level was associated with a 4% (HR: 1.04, 95% CI: 1.00–1.08, p = .045) higher mortality risk. Conclusions: Higher serum ALP level is associated with increased mortality solely in PD patients with RRF.

Interaction of Serum Alkaline Phosphatase and Folic Acid Treatment on Chronic Kidney Disease Progression in Treated Hypertensive Adults

“…Multiple previous studies have reported that ALP is associated with increased risk of mortality in CKD patients, despite whether they were dialysis-dependent ( Fan et al, 2017 ; Zhan et al, 2019 ) or non-dialysis dependent patient ( Taliercio et al, 2013 ; Sumida et al, 2018 ). To date, however, only two small studies ( Yamazoe et al, 2016 ; Majoni et al, 2020 ) have investigated the association between serum ALP and renal outcomes.…”

“…Multiple previous studies have reported that ALP is associated with increased risk of mortality in CKD patients, despite whether they were dialysis-dependent (Fan et al, 2017;Zhan et al, 2019) or non-dialysis dependent patient (Taliercio et al, 2013;Sumida Majoni et al, 2020) have investigated the association between serum ALP and renal outcomes. One study conducted in Japan (Yamazoe et al, 2016), reported that the risk of worsening renal function during hospitalization increased by 69 and 95%, respectively, in patients in ALP tertile 2 (203-278 IU/L) and tertile 3 (>278 IU/L), compared with those in tertile 1 (<203 IU/ L), among 972 patients with acute decompensated heart failure, and who were not on hemodialysis or peritoneal dialysis.…”

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

“…Elevated ALP level was associated with 27 $ 65% higher risks for mortality and hospitalization in the general population and survivors of myocardial infarction [33,34]. Epidemiologic studies have shown there is an association between higher ALP levels and mortality in non-dialysis-dependent chronic kidney disease, peritoneal dialysis patients with residual renal function, and incident dialysis patients [9,12,35,36]. High ALP levels were also associated with poor renal function and the progression of chronic kidney disease in the early stages of type 1 diabetes mellitus [20,21].…”

Changes of renal function after retrograde intrarenal surgery using flexible ureteroscope in renal stone patients

“…In addition, we found that higher ALP may prevent the improvement of renal function. ALP, an enzyme hydrolyzing pyrophosphate (a vascular calcification inhibitor), could promote heterotopic calcification (12). Thus, elevated ALP may be associated with the recurrence of renal stones, leading to further renal deterioration.…”