Abstract
BackgroundSerum alkaline phosphatase (ALP) levels have been reported to be associated with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. However, it is unclear whether serum ALP levels predict infection-related clinical outcomes in PD patients. The aim of this study was to determine the relationships between serum ALP levels, infection-related mortality and hospitalization in PD patients.MethodsPD patients from the Clinical Research Center registry for end-stage renal disease, a multicenter prospective observational cohort study in Korea, were included in the present study. Patients were categorized into three groups by serum ALP tertiles as follows: Tertile 1, ALP <78 U/L; Tertile 2, ALP = 78–155 U/L; Tertile 3, ALP >155 U/L. Tertile 1 was used as the reference category. The primary outcomes were infection-related mortality and hospitalization.ResultsA total of 1,455 PD patients were included. The median follow-up period was 32 months. The most common cause of infection-related mortality and hospitalization was PD-related peritonitis. Multivariate Cox regression analyses showed that patients in the highest tertiles of serum ALP levels were at higher risk of infection-related mortality (HR 2.29, 95% CI, 1.42–5.21, P = 0.008) after adjustment for clinical variables. Higher tertiles of serum ALP levels were associated with higher risk of infection-related hospitalization (Tertile 2: HR 1.56, 95% CI, 1.18–2.19, P = 0.009, tertile 3: HR 1.34, 95% CI, 1.03–2.62, P = 0.031).ConclusionsOur data showed that elevated serum ALP levels were independently associated with a higher risk of infection-related mortality and hospitalization in PD patients.
Highlights
Alkaline phosphatase (ALP) is a hydrolase enzyme that removes phosphate from nucleotides and proteins and is used as an early differentiation marker of osteoblast and osteoblastic activity [1]
Multivariate Cox regression analyses showed that patients in the highest tertiles of serum alkaline phosphatase (ALP) levels were at higher risk of infection-related mortality (HR 2.29, 95% confidence interval (CI), 1.42–5.21, P = 0.008) after adjustment for clinical variables
Higher tertiles of serum ALP levels were associated with higher risk of infection-related hospitalization (Tertile 2: hazard ratio (HR) 1.56, 95% CI, 1.18–2.19, P = 0.009, tertile 3: HR 1.34, 95% CI, 1.03–2.62, P = 0.031)
Summary
Alkaline phosphatase (ALP) is a hydrolase enzyme that removes phosphate from nucleotides and proteins and is used as an early differentiation marker of osteoblast and osteoblastic activity [1]. Epidemiologic studies have reported that increased serum total ALP levels are associated with higher all-cause or cardiovascular mortality and morbidity in hemodialysis (HD) patients [3,4,5]. The previous retrospective studies reported that chronic kidney disease (CKD)-mineral and bone disorders (MBD), an established risk factor for vascular calcification in CKD patients, was reported to be associated with short-term adverse outcomes of PDrelated peritonitis in PD patients [11,12]. Serum alkaline phosphatase (ALP) levels have been reported to be associated with allcause and cardiovascular mortality in peritoneal dialysis (PD) patients. It is unclear whether serum ALP levels predict infection-related clinical outcomes in PD patients. The aim of this study was to determine the relationships between serum ALP levels, infection-related mortality and hospitalization in PD patients.
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