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

Taliercio, Jonathan J.; Schold, Jesse D.; Simon, James F.; Arrigain, Susana; Tang, Anne; Saab, Georges; Nally, Joseph V.; Navaneethan, Sankar D.

doi:10.1053/j.ajkd.2013.04.012

Back to Previous Page

- Add this to...
- Twitter
- Facebook
- Google Bookmarks
- LinkedIn

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

Published Date:

Jun 12 2013

Publisher's site:

http://dx.doi.org/10.1053/j.ajkd.2013.04.012 New Site Icon

Source:

Am J Kidney Dis. 2013; 62(4):703-710.

[PDF-515.43 KB]

Details:

Personal Authors:

Taliercio, Jonathan J. ; Schold, Jesse D. ; Simon, James F. ; Arrigain, Susana ; Tang, Anne ; ... More ▼

Keywords:

[+]

Pubmed ID:

23769134

Pubmed Central ID:

PMC3783514

Description:

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.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

1R39OT22056/OT/OSTLTS CDC HHS/United States
DK094112/DK/NIDDK NIH HHS/United States
KL2 RR024990/RR/NCRR NIH HHS/United States
P60MD00265/MD/NIMHD NIH HHS/United States
R01 DK085185/DK/NIDDK NIH HHS/United States
R34 DK094112/DK/NIDDK NIH HHS/United States
RR024990/RR/NCRR NIH HHS/United States

Main Document Checksum:

[+]

Supporting Files:

	nihms477692.nxml	application/octet-stream
	nihms477692f1.gif	image/gif
	nihms477692f1.jpg	image/jpeg
	nihms477692f2.gif	image/gif
	nihms477692f2.jpg	image/jpeg
	nihms477692f3.gif	image/gif
	nihms477692f3.jpg	image/jpeg

No Related Documents.

You May Also Like:

Perspective and priorities for improvement of parathyroid hormone (PTH) measurement – A view from the IFCC Working Group for PTH☆

Personal Author:

Sturgeon, Catharine M; Sprague, Stuart; Almond, Alison; Cavalier, Etienne; Fraser, William D; Algeciras-Schimnich, Alicia; Singh, Ravinder; Souberbielle, Jean-Claude; Vesper, Hubert W.;

Corporate Author:

IFCC Working Group for PTH

Published:

Oct 13 2016

Source:

Clin Chim Acta. 467:42-47.

Description:

Parathyroid hormone (PTH) measurement in serum or plasma is a necessary tool for the exploration of calcium/phosphate disorders, and is widely used as a surrogate marker to assess skeletal and mineral disorders associated with chronic kidney disease ...

File Type:

[PDF - 696.14 KB]
Relationship between heart rate variability and pulse wave velocity and their association with patient outcomes in chronic kidney disease

Personal Author:

Chandra, Preeti; Sands, Robin L.; Gillespie, Brenda W.; Levin, Nathan W.; Kotanko, Peter; Kiser, Margaret; Finkelstein, Fredric; Hinderliter, Alan; Rajagopalan, Sanjay; Sengstock, David; Saran, Rajiv;

Published:

Jan 2014

Source:

Clin Nephrol. 2014 ; 81(1):9-19.

Description:

Arterial stiffness and low heart rate variability (HRV) have each been associated with increased cardiovascular risk in a variety of patient populations. We explored the relationship between HRV and pulse wave velocity (PWV measure of arterial stiffn...

File Type:

[PDF - 471.64 KB]
Race/Ethnicity, Dietary Acid Load and Risk of ESRD among U.S. Adults with CKD

Personal Author:

Crews, Deidra C.; Banerjee, Tanushree; Wesson, Donald E.; Morgenstern, Hal; Saran, Rajiv; Burrows, Nilka Ríos; Williams, Desmond E.; Powe, Neil R.;

Corporate Author:

for the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team

Published:

March 09 2018

Source:

Am J Nephrol. 47(3):174-181

Description:

Background : Dietary acid load (DAL) confers risk for CKD and CKD progression. We sought to determine the relation of DAL to racial/ethnic differences in risk of ESRD among persons with CKD. : Methods : Among 1123 non-Hispanic black (NHB) and white (...

File Type:

[PDF - 90.66 KB]
The Association of Urine Arsenic with Prevalent and Incident Chronic Kidney Disease: Evidence from the Strong Heart Study

Personal Author:

Zheng, Laura Y.; Umans, Jason G.; Yeh, Fawn; Francesconi, Kevin A.; Goessler, Walter; Silbergeld, Ellen K; Bandeen-Roche, Karen; Guallar, Eliseo; Howard, Barbara V.; Weaver, Virginia M.; Navas-Acien, Ana;

Published:

Jul 2015

Source:

Epidemiology. 26(4):601-612.

Description:

Background : Few studies have evaluated associations between low to moderate arsenic levels and chronic kidney disease (CKD). The objective was to evaluate the associations of inorganic arsenic exposure with prevalent and incident CKD in American Ind...

File Type:

[PDF - 527.16 KB]
Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA

Personal Author:

Gillespie, Brenda W.; Morgenstern, Hal; Hedgeman, Elizabeth; Tilea, Anca; Scholz, Natalie; Shearon, Tempie; Burrows, Nilka Rios; Shahinian, Vahakn B.; Yee, Jerry; Plantinga, Laura; Powe, Neil R.; McClellan, William; Robinson, Bruce; Williams, Desmond E.; Saran, Rajiv;

Published:

Nov 03 2015

Source:

Clin Kidney J. 2015; 8(6):772-780.

Description:

Background : Longer nephrology care before end-stage renal disease (ESRD) has been linked with better outcomes. : Methods : We investigated whether longer pre-end-stage renal disease (ESRD) nephrology care was associated with lower mortality at both ...

File Type:

[PDF - 600.52 KB]