Outcome predictability of serum alkaline phosphatase in men with pre-dialysis CKD

Csaba Kovesdy, Vitalie Ureche, Jun L. Lu, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background. Serum alkaline phosphatase (ALP) increases in patients with chronic kidney disease (CKD) and high-turnover bone disease. ALP may represent an adjunct marker of high bone turnover devoid of drawbacks of serum parathyroid hormone (PTH), and it may also be associated with cardiovascular calcification in CKD. Higher ALP has been recently associated with increased mortality and coronary calcification in dialysis patients. In pre-dialysis CKD patients, this association is not clear.Methods. We examined the association of baseline, time-varying and time-averaged ALP with all-cause mortality and the composite of pre-dialysis mortality or end-stage renal disease in a historical prospective cohort of 1158 male veterans with pre-dialysis CKD from a single institution by using multivariable-adjusted Cox models.Results. Higher ALP was associated with increased mortality irrespective of the statistical model. Time-averaged ALP displayed a consistent linear association with mortality: a 50-U/L higher serum ALP was associated with a multivariable-adjusted death hazard ratio (95% confidence interval) of 1.17 (1.08-1.28), P < 0.001. Baseline and time-varying ALP showed non-linear associations with mortality, with serum levels above 70 U/L in all models and with lower levels in time-varying models. Associations between ALP levels and the composite outcomes were similar. However, compared to serum PTH, mortality predictability of ALP appeared more incremental.Conclusions. Elevated ALP is associated with increased mortality in patients with pre-dialysis CKD. Low ALP appears to be associated with short-term mortality. Published by Oxford University Press on behalf of ERA-EDTA 2010. All rights reserved. For Permissions, please e-mail: journals.permissio2010Oxford University Press

Original languageEnglish (US)
Pages (from-to)3003-3011
Number of pages9
JournalNephrology Dialysis Transplantation
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

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Chronic Renal Insufficiency
Alkaline Phosphatase
Dialysis
Serum
Mortality
Parathyroid Hormone
Bone Remodeling
Bone Diseases
Postal Service
Statistical Models
Veterans
Proportional Hazards Models
Edetic Acid
Chronic Kidney Failure
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Outcome predictability of serum alkaline phosphatase in men with pre-dialysis CKD. / Kovesdy, Csaba; Ureche, Vitalie; Lu, Jun L.; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 25, No. 9, 01.09.2010, p. 3003-3011.

Research output: Contribution to journalArticle

Kovesdy, Csaba ; Ureche, Vitalie ; Lu, Jun L. ; Kalantar-Zadeh, Kamyar. / Outcome predictability of serum alkaline phosphatase in men with pre-dialysis CKD. In: Nephrology Dialysis Transplantation. 2010 ; Vol. 25, No. 9. pp. 3003-3011.
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N2 - Background. Serum alkaline phosphatase (ALP) increases in patients with chronic kidney disease (CKD) and high-turnover bone disease. ALP may represent an adjunct marker of high bone turnover devoid of drawbacks of serum parathyroid hormone (PTH), and it may also be associated with cardiovascular calcification in CKD. Higher ALP has been recently associated with increased mortality and coronary calcification in dialysis patients. In pre-dialysis CKD patients, this association is not clear.Methods. We examined the association of baseline, time-varying and time-averaged ALP with all-cause mortality and the composite of pre-dialysis mortality or end-stage renal disease in a historical prospective cohort of 1158 male veterans with pre-dialysis CKD from a single institution by using multivariable-adjusted Cox models.Results. Higher ALP was associated with increased mortality irrespective of the statistical model. Time-averaged ALP displayed a consistent linear association with mortality: a 50-U/L higher serum ALP was associated with a multivariable-adjusted death hazard ratio (95% confidence interval) of 1.17 (1.08-1.28), P < 0.001. Baseline and time-varying ALP showed non-linear associations with mortality, with serum levels above 70 U/L in all models and with lower levels in time-varying models. Associations between ALP levels and the composite outcomes were similar. However, compared to serum PTH, mortality predictability of ALP appeared more incremental.Conclusions. Elevated ALP is associated with increased mortality in patients with pre-dialysis CKD. Low ALP appears to be associated with short-term mortality. Published by Oxford University Press on behalf of ERA-EDTA 2010. All rights reserved. For Permissions, please e-mail: journals.permissio2010Oxford University Press

AB - Background. Serum alkaline phosphatase (ALP) increases in patients with chronic kidney disease (CKD) and high-turnover bone disease. ALP may represent an adjunct marker of high bone turnover devoid of drawbacks of serum parathyroid hormone (PTH), and it may also be associated with cardiovascular calcification in CKD. Higher ALP has been recently associated with increased mortality and coronary calcification in dialysis patients. In pre-dialysis CKD patients, this association is not clear.Methods. We examined the association of baseline, time-varying and time-averaged ALP with all-cause mortality and the composite of pre-dialysis mortality or end-stage renal disease in a historical prospective cohort of 1158 male veterans with pre-dialysis CKD from a single institution by using multivariable-adjusted Cox models.Results. Higher ALP was associated with increased mortality irrespective of the statistical model. Time-averaged ALP displayed a consistent linear association with mortality: a 50-U/L higher serum ALP was associated with a multivariable-adjusted death hazard ratio (95% confidence interval) of 1.17 (1.08-1.28), P < 0.001. Baseline and time-varying ALP showed non-linear associations with mortality, with serum levels above 70 U/L in all models and with lower levels in time-varying models. Associations between ALP levels and the composite outcomes were similar. However, compared to serum PTH, mortality predictability of ALP appeared more incremental.Conclusions. Elevated ALP is associated with increased mortality in patients with pre-dialysis CKD. Low ALP appears to be associated with short-term mortality. Published by Oxford University Press on behalf of ERA-EDTA 2010. All rights reserved. For Permissions, please e-mail: journals.permissio2010Oxford University Press

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