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- Title
Prognostic significance of pre-end-stage renal disease serum alkaline phosphatase for post-end-stage renal disease mortality in late-stage chronic kidney disease patients transitioning to dialysis.
- Authors
Keiichi Sumida; Molnar, Miklos Z.; Potukuchi, Praveen K.; Thomas, Fridtjof; Jun Ling Lu; Yoshitsugu Obi; Rhee, Connie M.; Streja, Elani; Kunihiro Yamagata; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.
- Abstract
Background. Higher serum alkaline phosphatase (ALP) levels have been associated with excess mortality in patients with nondialysis- dependent chronic kidney disease (NDD-CKD) and end-stage renal disease (ESRD). However, little is known about the impact of late-stage NDD-CKD ALP levels on outcomes after dialysis initiation. Methods. Among 17 732 US veterans who transitioned to dialysis between October 2007 and September 2011, we examined the association of serum ALP levels averaged over the last 6 months of the pre-ESRD transition period ('prelude period') with allcause, cardiovascular and infection-related mortality following dialysis initiation, using Cox (for all-cause mortality) and competing risk (for cause-specific mortality) regressions adjusted for demographics, comorbidities, medications, estimated glomerular filtration rate and serum albumin levels over the 6-month prelude period, and vascular access type at dialysis initiation. Results. During a median follow-up of 2.0 (interquartile range, 1.1-3.2) years following dialysis initiation, a total of 9196 allcause deaths occurred. Higher ALP levels were incrementally associated with higher all-cause, cardiovascular and infectionrelated mortality. Compared with patients in the lowest ALP quartile (<66.0U/L), those in the highest quartile (≥111.1U/L) had multivariable-adjusted hazard/subhazard ratios (95% confidence interval) of 1.42 (1.34-1.51), 1.43 (1.09-1.88) and 1.39 (1.09-1.78) for all-cause, cardiovascular and infection-related mortality, respectively. The associations remained consistent in various subgroups and after further adjustment for liver enzymes, serum phosphorus and intact parathyroid hormone levels. Conclusions. Higher pre-ESRD serum ALP levels are independently associated with higher post-ESRD mortality risk. Further studies are warranted to determine if interventions that lower pre- ESRD ALP levels reducemortality in incident dialysis patients.
- Subjects
CHRONIC kidney failure; BLOOD serum analysis; HEMODIALYSIS; ALKALINE phosphatase; MORTALITY; DIAGNOSIS; PROGNOSIS
- Publication
Nephrology Dialysis Transplantation, 2018, Vol 33, Issue 2, p264
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfw412