Details:

Alternative Title:
Am J Kidney Dis
Publisher's site:
http://dx.doi.org/10.1053/j.ajkd.2013.04.012
Personal Author:
Taliercio, Jonathan J. ; Schold, Jesse D. ; Simon, James F. ; Arrigain, Susana ; Tang, Anne ; ... More +
Taliercio, Jonathan J. ; Schold, Jesse D. ; Simon, James F. ; Arrigain, Susana ; Tang, Anne ; Saab, Georges ; Nally, Joseph V. ; Navaneethan, Sankar D. Less -
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.


Subject:
[+]
Aged
Alkaline Phosphatase
Cohort Studies
Disease Progression
Female
Humans
Kidney Failure, Chronic
Male
Prognosis
Renal Insufficiency, Chronic
Retrospective Studies
Severity Of Illness Index

Source:
Am J Kidney Dis. 2013; 62(4):703-710.
Pubmed ID:
23769134
Pubmed Central ID:
PMC3783514
Document Type:
Journal Article
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 ; ... More +
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 Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:d8d504ff8e8022eed08385f4ef07f00fc8bf7990a50a3992e6b127e58b24af46
File Type:

Supporting Files

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