title: Higher serum bone alkaline phosphatase as a predictor of mortality in male hemodialysis patients.
abstract: OBJECTIVE
  Higher serum alkaline phosphatase predicts lower mortality in chronic kidney disease and hemodialysis patients without liver dysfunction because it reflects high bone turnover. The purpose of our study was to compare the significance of serum bone alkaline phosphatase (BAP) with that of other bone markers in prediction of all-cause mortality(ACM) in male hemodialysis patients.
  
  
  METHODS
  The study was performed for 5 years. Serum BAP, intact osteocalcin (iOC), ß-CrossLaps (CTX), and intact parathyroid hormone (iPTH) were measured in 196 male hemodialysis patients without radiographic fracture. Their day-to-day variation during 5 consecutive days and diurnal variation were determined in 13 healthy males.
  
  
  RESULTS
  The patients were divided into higher and lower groups based on serum levels of bone markers(mean±SD: iPTH 218.6±214.5 pg/ml, BAP 23.6±12.2 U/L, iOC 42.8±45.2 ng/ml, CTX 1.71±1.23 nmol/L BCE). In Kaplan-Meier analysis, the higher BAP group had significantly higher ACM than the lower BAP group (P=0.013), whereas mortality did not differ between the higher and lower groups in other markers. Cox regression hazard analysis identified higher log BAP as a significant independent predictor [hazard ratio(HR) 8.32(95%CI:1.18-58.98)] for ACM after adjustment for various factors including pre-existing cardiovasucular disease, presence of DM. The significant association of mortality with serum BAP alone, in contrast with other markers including CTX [HR0.64 (95%CI:0.16-2.47)], iOC [HR0.97(95%CI:0.36-2.64)], iPTH [HR0.84(95%CI:0.44-1.60)], it may be due to the narrower day-to-day variation and the absence of diurnal variation in serum BAP compared to other markers.
  
  
  CONCLUSIONS
  Higher serum BAP may be a predictor of ACM in male hemodialysis patients.
authors.affiliation: Department of Metabolism, Endocrinology, Molecular Medicine, Osaka City University Graduate School of Medicine, Shirasagi Hospital, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Ikue
authors.initials: I
authors.lastname: Kobayashi
authors.forename: Kaori
authors.initials: K
authors.lastname: Shidara
authors.forename: Senji
authors.initials: S
authors.lastname: Okuno
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yamada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Imanishi
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Mori
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Shigeichi
authors.initials: S
authors.lastname: Shoji
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamakawa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001842:Bone and Bones / Q000201:enzymology* / Q000473:pathology; D016022:Case-Control Studies; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood; D003094:Collagen / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D006435:Renal Dialysis
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D010446:Peptide Fragments; C110762:glutamyl-lysyl-alanyl-histidyl-aspartyl-glycyl-glycyl-arginine; D015675:Osteocalcin; D003094:Collagen; D000469:Alkaline Phosphatase