Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients

Ronney Shantouf, Csaba Kovesdy, Youngmee Kim, Naser Ahmadi, Amanda Luna, Claudia Luna, Mehdi Rambod, Allen R. Nissenson, Matthew J. Budoff, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Background and objectives: Recent in vitro studies have shown a link between alkaline phosphatase and vascular calcification in patients with chronic kidney disease (CKD). High serum levels of alkaline phosphatase are associated with increased death risk in epidemiologic studies of maintenance hemodialysis (MHD) patients. We hypothesized that coronary artery calcification is independently associated with increased serum alkaline phosphatase levels in MHD patients. Design, setting, participants, & measurements: We examined the association of coronary artery calcification score (CACS) and alkaline phosphatase in 137 randomly selected MHD patients for whom markers of malnutrition, inflammation, and bone and mineral disorders were also measured. Results: Serum alkaline phosphatase was the only measure with significant and robust association with CACS (P < 0.003), whereas either other biochemical markers had no association with CACS or their association was eliminated after controlling for case-mix variables. Serum alkaline phosphatase >120 IU/L was a robust predictor of higher CACS and was particularly associated with the likelihood of CACS >400 (multivariate odds ratio 5.0 95% confidence interval 1.6 to 16.3; P = 0.007). Serum alkaline phosphatase of approximately 85 IU/L seemed to be associated with the lowest likelihood of severe coronary artery calcification, but in the lowest tertile of alkaline phosphatase, the CACS predictability was not statistically significant. Conclusions: An association between serum alkaline phosphatase level and CACS exists in MHD patients. Given the high burden of vascular calcification in patients with CKD, examining potential therapeutic interventions to modulate the alkaline phosphatase pathway may be warranted.

Original languageEnglish (US)
Pages (from-to)1106-1114
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume4
Issue number6
DOIs
StatePublished - Dec 1 2009

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Alkaline Phosphatase
Renal Dialysis
Coronary Vessels
Maintenance
Serum
Vascular Calcification
Chronic Renal Insufficiency
Osteitis
Malnutrition
Minerals
Epidemiologic Studies
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients. / Shantouf, Ronney; Kovesdy, Csaba; Kim, Youngmee; Ahmadi, Naser; Luna, Amanda; Luna, Claudia; Rambod, Mehdi; Nissenson, Allen R.; Budoff, Matthew J.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 4, No. 6, 01.12.2009, p. 1106-1114.

Research output: Contribution to journalArticle

Shantouf, R, Kovesdy, C, Kim, Y, Ahmadi, N, Luna, A, Luna, C, Rambod, M, Nissenson, AR, Budoff, MJ & Kalantar-Zadeh, K 2009, 'Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients', Clinical Journal of the American Society of Nephrology, vol. 4, no. 6, pp. 1106-1114. https://doi.org/10.2215/CJN.06091108
Shantouf, Ronney ; Kovesdy, Csaba ; Kim, Youngmee ; Ahmadi, Naser ; Luna, Amanda ; Luna, Claudia ; Rambod, Mehdi ; Nissenson, Allen R. ; Budoff, Matthew J. ; Kalantar-Zadeh, Kamyar. / Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients. In: Clinical Journal of the American Society of Nephrology. 2009 ; Vol. 4, No. 6. pp. 1106-1114.
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