serum alkaline phosphatase levels and mortality of chronic hemodialysis patients血清碱性磷酸酶水平和慢性血液透析患者的死亡率.pdf

International Journal of Clinical Medicine, 2011, 2, 388-393 doi:10.4236/ijcm.2011.24065 Published Online September 2011 (http://www.SciRP.org/journal/ijcm) Serum Alkaline Phosphatase Levels and Mortality of Chronic Hemodialysis Patients 1 2 2 2 1* Tetsuri Yamashita , Junichi Shizuku , Takashi Ohba , Takashi Kabaya , Kosaku Nitta 1Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan; 2Minami Senju Hospital, Tokyo, Japan. * Email: knitta@kc.twmu.ac.jp Received April 26th, 2011; revised July 6th, 2011; accepted July 25th, 2011. ABSTRACT Objective: Alkaline phosphatase (ALP) is considered a biomarker of high bone turnover in hemodialysis (HD) patients with secondary hyperparathyroidism. This study was conducted to determine whether high serum ALP levels are asso- ciated with increased all-cause mortality of HD patients. Patients and Methods : This was a retrospective cohort study conducted at a single center. The subjects were 195 patients on chronic HD therapy who were followed up for a 5 years, and relationships between their baseline data and outcomes were assessed statistically. The serum ALP level was used as the predictor, and the primary end point was all-cause mortality. Results : Based on the median serum ALP of 236 IU/L , the subjects were divided into a low-ALP group (236 IU/l) and a high-ALP group (≥236 IU/l). The high-ALP group was older and had a longer dialysis vintage, lower serum phosphorus concentrations, and higher serum para- thyroid hormone levels, and they also had lower serum albumin levels and higher C-reactive protein values. In a mul- tivariate Cox model in which the baseline serum ALP levels were used adjusted for age, gender, HD vintage, comorbid- ity, bone metabolism parameters, and serum liver enzyme levels, each doubling of the serum ALP level was associated with a