Impact of the serum bone-specific alkaline phosphatase level at the initiation of hemodialysis therapy for end-stage renal disease on cardiovascular events

Abstract

BackgroundPatients with end-stage renal disease (ESRD) have high rates of hospitalization for cardiovascular (CV) events and short-term mortality after the initiation of hemodialysis (HD) therapy. To improve outcomes, it is important to identify predictive laboratory markers. We investigated whether the serum bone-specific alkaline phosphatase (BAP) level at the initiation of HD therapy for ESRD was associated with adverse events. MethodsThis was a retrospective cohort study of 47 ESRD outpatients who were referred to our clinic for HD. The serum BAP level was measured within 1month after the initiation of HD. Patients were divided into high-BAP and low-BAP groups according to the median serum BAP level (24.6U/L). The impact of the serum BAP level on CV events (coronary artery disease, peripheral arterial disease, cerebrovascular disease, other CV events including aortic dissection, and mortality) was investigated. ResultsDuring a median follow-up period of 72months, CV events occurred in 14 patients (29.8%). Kaplan–Meier analysis showed that the disease-free and overall survival rates were lower in the high-BAP group than in the low-BAP group (p=0.003 and p=0.037, respectively, log-rank test). After adjustment for age, sex, and other confounding factors, Cox proportional hazards analysis found that the high-BAP group had a 5.9-fold higher rate of CV events than the low-BAP group (hazard ratio: 5.89; 95% confidence interval: 1.184–29.309; p=0.030). ConclusionsThe serum BAP level at the initiation of HD therapy for ESRD is a useful non-invasive biomarker for predicting CV events.