Abstract
Studies on serum alkaline phosphatase (ALP) and mortality risk in patients with end-stage renal disease (ESRD) undergoing dialysis have yielded conflicting results. This meta-analysis was designed to assess the association of serum ALP levels with cardiovascular or all-cause mortality risk among patients on dialysis. PubMed and Embase databases were searched until March 2017 for studies evaluating the association of serum ALP levels and cardiovascular or all-cause mortality risk in adult patients with ESRD undergoing maintenance hemodialysis or chronic peritoneal dialysis. Twelve studies enrolling 393,200 patients on dialysis were included. Compared with the reference low serum ALP category, pooled adjusted hazard risk (HR) of all-cause mortality was 1.46 (95% confidence interval [CI] 1.30–1.65) for patients on hemodialysis and 1.93 (95% CI 1.71–2.17) for peritoneal patients on dialysis. In addition, elevated serum ALP significantly increased cardiovascular mortality among patients on peritoneal dialysis (HR 2.39; 95% CI 1.23–4.65) but not in patients on hemodialysis (HR 1.08; 95% CI 0.84–1.40). Elevated serum ALP was an independent risk factor for all-cause mortality among patients on hemodialysis or peritoneal dialysis. Further well-designed prospective studies are needed to investigate the association of high serum ALP levels with cardiovascular mortality among patients on dialysis.
Highlights
Chronic kidney disease (CKD) is a global public health concern[1]
This study is the first meta-analysis to evaluate the association between serum Alkaline phosphatase (ALP) and risk of cardiovascular and all-cause mortality in patients on dialysis
Our meta-analysis indicated that elevated serum ALP levels appeared to significantly increase cardiovascular mortality among patients on peritoneal dialysis but not in patients with hemodialysis
Summary
Chronic kidney disease (CKD) is a global public health concern[1]. End-stage renal disease (ESRD) is a chronic and progressive decline in kidney function. Several[8,9,10,11,12,13,14,15,16,17,18] but not all[19,20] epidemiologic studies reported that elevated serum levels of ALP are associated with increased all-cause mortality among patients on hemodialysis and peritoneal dialysis. Three studies[10,15,20] assessed the association of serum ALP with cardiovascular mortality among patients on hemodialysis.
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