An association between time-varying serum alkaline phosphatase concentrations and mortality rate in patients undergoing peritoneal dialysis: a five-year cohort study

Ying Liu,Chih-Hsiung Lee,Shang-Chih Liao,Jin-Gang Zhu,Wen Xiu Chang,Jin-Bor Chen,Ben-Chung Cheng

doi:10.1038/srep43314

Abstract

The relationship between serum alkaline phosphatase (ALP) concentrations and mortality in peritoneal dialysis (PD) patients is rarely reported. We enrolled 667 PD patients in one PD centre in Taiwan to retrospectively examine the association between three ALP concentrations (baseline, time-averaged, time-dependent) and mortality over a 5-year period (2011–2015). Baseline data collection included demographics, clinical, and laboratory parameters. Multivariable-adjusted Cox models were used to analyse the association. Four ALP quartiles were defined at the baseline: ≤62, 63–82, 83–118, and ≥119 U/L. Of 667 patients, 65 patients died, of which 8 patients died due to cardiovascular disease. Females were predominant in the higher ALP quartiles, and 24-h urine volume was significantly proportionately decreased in the higher ALP quartiles. ALP quartiles expressed by the three models were not associated with all-cause or cardiovascular mortalities after adjusting for demographics, liver function, bone metabolism, mortality, hemoglobin, and 24-h urine volume. In conclusion, ALP concentrations were not associated with death risk in PD patients over the 5-year period.

Highlights

Characteristic Total All-Cause Death CV Death Age mean, standard deviations (SD) Dialysis Duration mean, SD Sex Male Female Etiology of renal failure Glomerulonephritis Diabetes mellitus Others Antihypertensive use Yes Parathyroidectomy Yes Hepatitis B Yes Hepatitis C Yes 24 hr urinary volume mean, SD
TA, and TD values demonstrated significantly increased all-cause mortality after adjusting for sex, age, 24-h urine volume, hemoglobin, albumin, aspartate aminotransferase (AST), and alanine transaminase (ALT)
Increases in serum albumin level by 1 gm/dL showed reduced death risk for all-causes (hazard ratio [hazard ratios (HRs)] 0.19, 95% confidence interval (CI) 0.10–0.36, p < 0.001 at baseline; HR 0.12, 95% CI 0.06–0.26, p < 0.001 at TA; HR 0.19, 95% CI 0.10–0.36, p < 0.001 at TD values), and CV mortalities (HR 0.03, 95% CI 0.00–0.31, p = 0.0029 at baseline; HR 0.00, 95% CI 0.00–0.07, p = 0.0002 at TA; HR 0.01, 95% CI 0.00–0.12, p = 0.0004 at TD values) by fully-adjusted analysis (Tables 7 and 8)

Summary

Introduction

Characteristic Total All-Cause Death CV Death Age (year) mean, SD Dialysis Duration (year) mean, SD Sex Male Female Etiology of renal failure Glomerulonephritis Diabetes mellitus Others Antihypertensive use Yes Parathyroidectomy Yes Hepatitis B Yes Hepatitis C Yes 24 hr urinary volume (ml) mean, SD. Death risk was not increased for ALP quartiles expressed by baseline, TA, or TD levels in unadjusted analysis (Tables 3 and 4). TA, and TD values demonstrated significantly increased all-cause mortality after adjusting for sex, age, 24-h urine volume, hemoglobin, albumin, aspartate aminotransferase (AST), and alanine transaminase (ALT) (model 2).

Results

Conclusion