Liu Xinhui, Guo Qunying, Feng Xiaoran, Wang Juan, Wu Juan, Mao Haiping, Huang Fengxian, Yu Xueqing, Yang Xiao
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health, Guangdong, China.
Clin J Am Soc Nephrol. 2014 Apr;9(4):771-8. doi: 10.2215/CJN.08280813. Epub 2014 Jan 23.
Elevated total serum alkaline phosphatase levels have been associated with higher mortality in the general population, CKD patients, and hemodialysis patients. However, in peritoneal dialysis patients, this association has received little attention. The aim of this study was to evaluate the association between alkaline phosphatase and all-cause and cardiovascular mortality in peritoneal dialysis patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this single center retrospective cohort study, 1021 incident peritoneal dialysis patients from January 1, 2006, to December 31, 2010 with baseline serum alkaline phosphatase values were enrolled. Collected baseline data included demographic characteristics and clinical and laboratory measurements. All patients were followed until December 31, 2012. The associations of total serum alkaline phosphatase levels with all-cause and cardiovascular mortality were assessed using multivariable-adjusted Cox models.
Of 1021 patients, mean age was 47.5 (± 15.5) years, 59.1% of patients were men, and 22.8% of patients were diabetic. The median serum alkaline phosphatase level was 64 U/L (interquartile range=52-82 U/L). During a median 31-month (interquartile range=19-45 months) follow-up period, 203 patients died, of which 109 deaths were caused by cardiovascular disease. After adjusting for demographics, comorbid conditions, liver function, and bone metabolism parameters, the highest alkaline phosphatase quartile was significantly associated with a hazard ratio for all-cause mortality of 1.70 (95% confidence interval, 1.06 to 2.74, P=0.03) and a hazard ratio for cardiovascular mortality of 1.94 (95% confidence interval, 1.02 to 3.72, P=0.04). Each 10 U/L higher baseline alkaline phosphatase level was associated with 4% (95% confidence interval, 1.00 to 1.08, P=0.04) and 7% (95% confidence interval, 1.02 to 1.11, P=0.003) higher risk of all-cause and cardiovascular mortality, respectively.
Higher total serum alkaline phosphatase levels at the commencement of peritoneal dialysis were independently associated with all-cause and cardiovascular mortality in peritoneal dialysis patients.
血清总碱性磷酸酶水平升高与普通人群、慢性肾脏病患者及血液透析患者的较高死亡率相关。然而，在腹膜透析患者中，这种关联很少受到关注。本研究的目的是评估碱性磷酸酶与腹膜透析患者全因死亡率和心血管死亡率之间的关联。
设计、地点、参与者及测量：在这项单中心回顾性队列研究中，纳入了2006年1月1日至2010年12月31日期间1021例有基线血清碱性磷酸酶值的新入腹膜透析患者。收集的基线数据包括人口统计学特征以及临床和实验室测量数据。所有患者随访至2012年12月31日。使用多变量调整的Cox模型评估血清总碱性磷酸酶水平与全因死亡率和心血管死亡率之间的关联。
1021例患者的平均年龄为47.5（±15.5）岁，59.1%为男性，22.8%为糖尿病患者。血清碱性磷酸酶水平中位数为64 U/L（四分位间距=52 - 82 U/L）。在中位31个月（四分位间距=19 - 45个月）的随访期内，203例患者死亡，其中109例死于心血管疾病。在调整了人口统计学、合并症、肝功能和骨代谢参数后，碱性磷酸酶最高四分位数与全因死亡率的风险比为1.70（95%置信区间，1.06至2.74，P = 0.03），与心血管死亡率的风险比为1.94（95%置信区间，1.02至3.72，P = 0.04）。基线碱性磷酸酶水平每升高10 U/L，全因死亡率和心血管死亡率的风险分别升高4%（95%置信区间，1.00至1.08，P = 0.04）和7%（95%置信区间，1.02至1.11，P = 0.003）。
腹膜透析开始时较高的血清总碱性磷酸酶水平与腹膜透析患者的全因死亡率和心血管死亡率独立相关。
