Abstract 17213: Serum Alkaline Phosphatase Elevation is an Independent Predicting Factor of Worsening Renal Function in the Patients with Acute Heart Failure

Abstract

Background: Worsening renal function (WRF) has been associated with poor outcome in the patients with acute heart failure (AHF). Recently, venous congestion had been paid attention to the important predictor of WRF in AHF. Abnormal serum alkaline phosphatase (ALP) was reported as a biological marker of liver congestion and of the extent of right sided filling pressure in AHF. In this study, we evaluated the relationship between ALP and development of WRF in AHF. Method: We enrolled consecutive patients hospitalized due to AHF in cardiovascular center of St Luke’s International Hospital, Tokyo, Japan from January, 2004 to December, 2013. We excluded the patients either on dialysis, estimated glomerular filtration rate (eGFR) under 15 ml/min/m2, or primary liver disease. We defined WRF as elevation of serum creatinine of 0.3 mg/dl or above raised from admission to discharge. We classified patients into tertiles by baseline measurements of ALP. We performed multivariate analysis to make the prediction model of WRF. Result: Total 1245 patients (age 76.4±12.9 years old, male 54.8%) were enrolled. During hospitalization, 166 (13.3%) patients developed WRF. Patients were classified into tertiles (<77, 77 to 203, >203 IU/L). Compared with the lowest ALP tertile, middle and the highest ALP tertile groups developed WRF more frequently (8.4% vs 15.5% vs 16.8%, P=0.003). In multivariate logistic regression, after adjustment of age, gender, and other risk factors, we found eGFR (Odds ratio (OR) 0.978, 95%Confidence Interval (CI) 0.967 to 0.987, P<0.001), diabetes mellitus (OR 1.83, CI 1.19 to 2.80, P=0.005), norepinephrine use (OR 1.65, CI 1.04 to 2.61, P=0.03), albumin (OR 0.507, CI 0.337 to 0.764, P=0.001), middle tertile ALP (OR 1.81, CI 1.07 to 3.06, P=0.02), and highest tertile ALP (OR 2.08, CI 1.24 to 3.48, P=0.005) compared with lowest tertile were independent variable to predict WRF. Conclusion: Our study showed that elevated serum ALP is an independent predicting factor for WRF in the patients with AHF.