Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Am J Kidney Dis. 2013 Oct;62(4):703-10. doi: 10.1053/j.ajkd.2013.04.012. Epub 2013 Jun 12.
Elevated total serum alkaline phosphatase (ALP) levels have been associated with mortality in the general population and in dialysis patients.
Retrospective cohort study.
SETTING & PARTICIPANTS: 28,678 patients with chronic kidney disease (CKD) stages 3 and 4 (estimated glomerular filtration rate, 15-59 mL/min/1.73 m(2)) were identified using the Cleveland Clinic CKD Registry. CKD was defined as 2 estimated glomerular filtration rate values <60 mL/min/1.73 m(2) drawn more than 90 days apart using the CKD-EPI (CKD Epidemiology Collaboration) creatinine equation.
ALP levels measured using the calorimetric assay were examined as quartiles (quartile [Q]1, <66 U/L; Q2, 66-81 U/L; Q3, 82-101 U/L; and Q4, ≥102 U/L) and as a continuous measure.
OUTCOMES & MEASUREMENTS: All-cause mortality and end-stage renal disease (ESRD) were ascertained using the Social Security Death Index and US Renal Data System.
After a median follow-up of 2.2 years, 588 patients progressed to ESRD and 4,755 died. There was a graded increase in risk of mortality with higher ALP quartiles (Q2, Q3, and Q4) compared to the reference quartile (Q1) after adjusting for demographics, comorbid conditions, use of relevant medications, and liver function test results. The highest ALP quartile was associated with an HR for ESRD of 1.38 (95% CI, 1.09-1.76). Each 1-SD (42.7 U/L) higher ALP level was associated with 15% (95% CI, 1.09-1.22) and 16% (95% CI, 1.14-1.18) increased risk of ESRD and mortality, respectively.
Single-center observational study; lack of complete data, including parathyroid hormone level, for all study participants, and attrition bias.
Higher serum ALP levels in patients with CKD stages 3-4 were associated independently with all-cause mortality and ESRD.
血清总碱性磷酸酶（ALP）水平升高与普通人群和透析患者的死亡率相关。
回顾性队列研究。
使用克利夫兰诊所 CKD 登记处确定了 28678 名患有慢性肾脏病（CKD）3 期和 4 期（估计肾小球滤过率，15-59 mL/min/1.73 m2）的患者。CKD 定义为使用 CKD-EPI（CKD 流行病学合作）肌酐方程两次估计肾小球滤过率值<60 mL/min/1.73 m2，两次值相隔超过 90 天。
使用比色法测量的 ALP 水平被分为四个四分位数（Q1<66 U/L；Q2，66-81 U/L；Q3，82-101 U/L；Q4，≥102 U/L）和连续测量。
使用社会保障死亡指数和美国肾脏数据系统确定全因死亡率和终末期肾脏疾病（ESRD）。
中位随访 2.2 年后，588 例患者进展为 ESRD，4755 例患者死亡。与参考四分位数（Q1）相比，调整人口统计学、合并症、相关药物使用和肝功能试验结果后，较高的 ALP 四分位数（Q2、Q3 和 Q4）的死亡率风险呈梯度增加。最高的 ALP 四分位数与 ESRD 的 HR 为 1.38（95%CI，1.09-1.76）。ALP 水平每升高 1 个标准差（42.7 U/L），ESRD 和死亡率的风险分别增加 15%（95%CI，1.09-1.22）和 16%（95%CI，1.14-1.18）。
单中心观察性研究；缺乏所有研究参与者的完整数据，包括甲状旁腺激素水平，以及存在失访偏倚。
CKD 3-4 期患者血清 ALP 水平升高与全因死亡率和 ESRD 独立相关。
