Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients.
BACKGROUND
Serum alkaline phosphatase (ALP) levels have been reported to be associated with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. However, it is unclear whether serum ALP levels predict infection-related clinical outcomes in PD patients. The aim of this study was to determine the relationships between serum ALP levels, infection-related mortality and hospitalization in PD patients.


METHODS
PD patients from the Clinical Research Center registry for end-stage renal disease, a multicenter prospective observational cohort study in Korea, were included in the present study. Patients were categorized into three groups by serum ALP tertiles as follows: Tertile 1, ALP <78 U/L; Tertile 2, ALP = 78-155 U/L; Tertile 3, ALP >155 U/L. Tertile 1 was used as the reference category. The primary outcomes were infection-related mortality and hospitalization.


RESULTS
A total of 1,455 PD patients were included. The median follow-up period was 32 months. The most common cause of infection-related mortality and hospitalization was PD-related peritonitis. Multivariate Cox regression analyses showed that patients in the highest tertiles of serum ALP levels were at higher risk of infection-related mortality (HR 2.29, 95% CI, 1.42-5.21, P = 0.008) after adjustment for clinical variables. Higher tertiles of serum ALP levels were associated with higher risk of infection-related hospitalization (Tertile 2: HR 1.56, 95% CI, 1.18-2.19, P = 0.009, tertile 3: HR 1.34, 95% CI, 1.03-2.62, P = 0.031).


CONCLUSIONS
Our data showed that elevated serum ALP levels were independently associated with a higher risk of infection-related mortality and hospitalization in PD patients.
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Seun Deuk
SD
Hwang
Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
Su-Hyun
SH
Kim
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Young Ok
YO
Kim
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Dong Chan
DC
Jin
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ho Chul
HC
Song
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Euy Jin
EJ
Choi
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Yong-Lim
YL
Kim
Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea.
Yon-Su
YS
Kim
Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
Shin-Wook
SW
Kang
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Nam-Ho
NH
Kim
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Chul Woo
CW
Yang
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Cell Death Disease Research Center, The Catholic University of Korea, Seoul, Korea.
Yong Kyun
YK
Kim
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea; D012307:Risk Factors; D016019:Survival Analysis
D015415:Biomarkers; D000469:Alkaline Phosphatase