High alkaline phosphatase levels in hemodialysis patients are associated with higher risk of hospitalization and death.
We evaluated risks associated with elevated alkaline phosphatase in hemodialysis patients using longitudinal data from the Dialysis Outcomes and Practice Patterns Study, a prospective observational study of hemodialysis patients in 12 countries. Alkaline phosphatase levels were normalized by the upper limit of the laboratory-reported reference range. Cause-specific hospitalization and mortality risks were evaluated using Cox proportional hazards models, stratified by region and adjusted for phosphorus, calcium, albumin, parathyroid hormone, case mix, and numerous comorbidities. The odds of high normalized alkaline phosphatase were increased twofold in the United States in comparison to Japan. Elevations of normalized alkaline phosphatase were significantly associated with several comorbid conditions, increased fractures, parathyroidectomy, risk of hospitalization due to major adverse cardiac events, higher all-cause cardiovascular, and infection-related mortality risk. Our results also show that elevated serum normalized alkaline phosphatase was associated with higher risks of hospitalization and death in hemodialysis patients, independent of calcium, phosphorus, and parathyroid hormone levels.
Blayney
Margaret J
MJ
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA. Margaret.Blayney@ArborResearch.org
Pisoni
Ronald L
RL
Bragg-Gresham
Jennifer L
JL
Bommer
Juergen
J
Piera
Luis
L
Saito
Akira
A
Akiba
Takashi
T
Keen
Marcia L
ML
Young
Eric W
EW
Port
Friedrich K
FK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D002118:Calcium / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000097:blood / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D012307:Risk Factors
D010281:Parathyroid Hormone; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium