Fein Paul A, Asadi Sara, Singh Priyanka, Hartman William, Stuto Steven, Chattopadhyay Jyotiprakas, Avram Morrell M
From: Avram Division of Nephrology, SUNY Downstate Medical Center UHB at Long Island College Hospital, Brooklyn, NY, USA.
Adv Perit Dial. 2013;29:61-3.
Elevated levels of serum alkaline phosphatase (AlkPhos) have been reported to be associated with increased mortality risk in hemodialysis (HD) patients. We examined the association of serum AlkPhos with all-cause mortality in our PD patients. The study enrolled 90 PD patients beginning in 1995. On enrollment, demographics and clinical and biochemical data were recorded. Patients were followed to September 2011. Mean age of the enrollees was 52 years, with 61% being women, and most (81%) being of African descent. Mean and median AlkPhos were 135 U/L and 113 U/L respectively. Mean and maximum follow-up were 2.61 and 16 years respectively. As expected, AlkPhos correlated directly with serum intact parathyroid hormone (r = 0.36, p = 0.003). In a Cox multivariate regression analysis with adjustment for confounding variables, AlkPhos as a continuous (relative risk: 1.016; p = 0.004) anda categorical variable [> 120 U/L and < or = 120 U/L (relative risk: 6.0; p = 0.03)] remained a significant independent predictor of mortality. For each unit increase in enrollment AlkPhos, there was a 1.6% increase in the relative risk of death. Elevated serum AlkPhos is significantly and independently associated with increased mortality risk in our PD patients followed for up to 16 years. AlkPhos should be evaluated prospectively as a potential therapeutic target in clinical practice.
据报道，血液透析（HD）患者血清碱性磷酸酶（AlkPhos）水平升高与死亡风险增加相关。我们研究了血清AlkPhos与腹膜透析（PD）患者全因死亡率之间的关联。该研究纳入了自1995年起开始的90例PD患者。入组时，记录了人口统计学以及临床和生化数据。对患者进行随访至2011年9月。入组者的平均年龄为52岁，61%为女性，且大多数（81%）为非洲裔。AlkPhos的均值和中位数分别为135 U/L和113 U/L。平均随访时间和最长随访时间分别为2.61年和16年。正如预期的那样，AlkPhos与血清完整甲状旁腺激素直接相关（r = 0.36，p = 0.003）。在对混杂变量进行校正的Cox多因素回归分析中，AlkPhos作为连续变量（相对风险：1.016；p = 0.004）以及分类变量[> 120 U/L和<或 = 120 U/L（相对风险：6.0；p = 0.03）]仍然是死亡率的显著独立预测因素。入组时AlkPhos每升高一个单位，死亡相对风险增加1.6%。在我们随访长达16年的PD患者中，血清AlkPhos升高与死亡风险增加显著且独立相关。在临床实践中，应前瞻性地评估AlkPhos作为潜在治疗靶点的可能性。
