title: Serum alkaline phosphatase as a predictor of worsening renal function in patients with acute decompensated heart failure.
abstract: BACKGROUND
  Venous congestion has come into focus as an important hemodynamic factor for worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). Serum alkaline phosphatase (ALP) was reported as a biological marker of liver congestion in ADHF. The purpose of this study was to determine whether ALP is a predictor of WRF in patients with ADHF.
  
  
  METHODS
  We enrolled consecutive patients admitted to a single cardiovascular center with ADHF, and defined WRF as an increase in creatinine of >0.3 mg/dl during hospitalization and chronic kidney disease (CKD) as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2). The patients were classified into tertiles by ALP level (<203, 203-278, and >278 IU/L).
  
  
  RESULTS
  A total of 972 patients (mean age, 76±13 years; 54% male) were retrospectively analyzed. WRF was identified in 132 patients (13.6%). In multivariate logistic regression analysis, baseline CKD [odds ratio (OR) 2.46, 95% confidence interval (CI) 1.48-4.08, p<0.001], serum albumin (OR 0.52, 95% CI 0.35-0.77, p=0.001), and diabetes (OR 2.07, 95% CI 1.37-3.12, p<0.001) were associated with WRF. Compared with the lowest tertile (ALP <203 IU/L), an adjusted OR of WRF was 1.69 (95% CI 1.02-2.79, p=0.04) in the middle tertile (ALP, 203-278 IU/L) and 1.95 (95% CI 1.20-3.21, p=0.008) in the highest tertile (ALP >278 IU/L).
  
  
  CONCLUSIONS
  Serum ALP is an independent predictor of WRF in the clinical course of ADHF.
authors.affiliation: Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: masahiro.yamazoe@gmail.com.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamazoe
authors.affiliation: Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mizuno
authors.affiliation: Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Nishi
authors.affiliation: Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Niwa
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000208:Acute Disease; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D003404:Creatinine; D000469:Alkaline Phosphatase
keywords: Alkaline phosphatase; Heart failure; Liver function; Worsening renal function