Abstract
Renal hyperfiltration, which is associated with renal injury, occurs in diabetic or obese individuals. Serum alkaline phosphatase (ALP) level is also elevated in patients with diabetes (DM) or metabolic syndrome (MS), and increased urinary excretion of ALP has been demonstrated in patients who have hyperfiltration and tubular damage. However, little was investigated about the association between hyperfiltration and serum ALP level. A retrospective observational study of the 21,308 adults in the Korea National Health and Nutrition Examination Survey IV-V databases (2008–2011) was performed. Renal hyperfiltration was defined as exceeding the age- and sex-specific 97.5th percentile. We divided participants into 4 groups according to their estimated glomerular filtration rate (eGFR): >120, 90–119, 60–89, and <60 mL/min/1.73 m2. The participants with eGFR >120 mL/min/1.73 m2 showed the highest risk for MS, in the highest ALP quartiles (3.848, 95% CI, 1.876–7.892), compared to the lowest quartile. Similarly, the highest risk for DM, in the highest ALP quartiles, was observed in participants with eGFR >120 ml/min/1.73 m2 (2.166, 95% CI, 1.084–4.329). ALP quartiles were significantly associated with albuminuria in participants with eGFR ≥ 60 ml/min/1.73m2. The highest ALP quartile had a 1.631-fold risk elevation for albuminuria with adjustment of age and sex. (95% CI, 1.158-2.297, P = 0.005). After adjustment, the highest ALP quartile had a 1.624-fold risk elevation, for renal hyperfiltration (95% CI, 1.204–2.192, P = 0.002). In addition, hyperfiltration was significantly associated with hemoglobin, triglyceride, white blood cell count, DM, smoking, and alcohol consumption (P<0.05). The relationship between serum ALP and metabolic disorders is stronger in participants with an upper-normal range of eGFR. Higher ALP levels are significantly associated with renal hyperfiltration in Korean general population.
Highlights
The glomerular filtration rate (GFR) represents the flow rate of fluid filtered through the kidney and is decided by 3 factors: glomerular blood flow, an ultrafiltration coefficient, and the hydraulic pressure difference across the kidney membrane [1]
Higher serum Alkaline phosphatase (ALP) was associated with older age and the male sex (P
Serum ALP was significantly related to diabetes mellitus (DM) and metabolic syndrome (MS) in participants with estimated glomerular filtration rate (eGFR) > 60ml/min/1,73m2, and these relationships were stronger in participants with an upper-normal range of eGFR
Summary
The glomerular filtration rate (GFR) represents the flow rate of fluid filtered through the kidney and is decided by 3 factors: glomerular blood flow, an ultrafiltration coefficient, and the hydraulic pressure difference across the kidney membrane [1]. In increased GFR, known as hyperfiltration, these factors change, causing glomerular hypertension, subsequent glomerulosclerosis, PLOS ONE | DOI:10.1371/journal.pone.0122921. Renal Hyperfiltration and Serum Alkaline Phosphatase tubular injury, and renal function decline [1,2,3]. Hyperfiltration may occur in healthy individuals, and in individuals with pathologic conditions such as diabetes, obesity, polycystic kidney disease, and focal segmental glomerulosclerosis [4,5,6,7]. Serum ALP level is elevated in patients with conditions that are associated with hyperfiltration, such as diabetes mellitus (DM) and metabolic syndrome (MS) [9,10]. The urinary excretion of ALP is increased in patients with compensatory hyperfiltration [11]. A small study noted that serum ALP level was higher in diabetic patients with hyperfiltration [12]. Little was investigated about the relationship between serum ALP and hyperfiltration far
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