Kang Seok Hui, Do Jun Young, Kim Jun Chul
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea.
Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea.
Front Med (Lausanne). 2021 May 17;8:657957. doi: 10.3389/fmed.2021.657957. eCollection 2021.
Alkaline phosphatase (ALP) is an indicator for checking liver or bone disorders, but recent studies have shown the possibility of an additive indicator beyond the simple mineral-bone status in dialysis patients. The aim of the study was to evaluate the ALP level and various indicators for malnutrition, physical performance, or hospitalization in patients on hemodialysis (HD). This study was an observational study ( = 84). We included all patients undergoing HD with the following criteria: age ≥ 20 years, duration of dialysis ≥ 6 months, ability to ambulate without an assistive device, ability to communicate with the interviewer, and no hospitalization within the last 3 months before enrollment. Furthermore, none of the patients had liver disease. We recommended abstinence of alcohol for ≥ 1 month for the duration of the study. The patients were divided into tertiles based on the ALP level. Muscle mass [appendicular muscle mass index using dual-energy X-ray absorptiometry (ASM/Ht), thigh muscle area index using computed tomography (TMA/Ht)], strength [handgrip strength (HGS)], and physical performance [gait speed (GS), sit-to-stand for 30-s test (STS30), 6-min walk test (6-MWT), or Short Physical Performance Battery test (SPPB)] were evaluated. The number of hospitalizations was also evaluated. The ALP level in the low, middle, and high tertiles was 50.5 ± 7.5, 69.8 ± 5.4, and 113.3 ± 47.3 IU/l, respectively. The high tertile group showed the poorest trends in ASM/Ht, TMA/Ht, HGS, GS, STS30, and 6-MWT compared to the other tertile groups. Logistic regression analysis showed that the high tertile group for low HGS, low GS, or low SPPB had a higher odds ratio compared to the other tertiles. Subgroup analyses according to age, sex and diabetes mellitus showed similar trends as in the total cohort. Hospitalization-free survival rates after 300 days in the high tertile and the other tertiles were 53.8 and 77.2%, respectively ( = 0.105). The present study demonstrated that ALP is associated with muscle mass, strength, and physical performance in patients on maintenance HD. In addition, the trend showed better hospitalization-free survival in the low or middle tertiles than in the high tertile. ALP can be considered as a simple and useful indicator to detect malnutrition, physical performance, or hospitalization in patients on HD.
碱性磷酸酶（ALP）是检查肝脏或骨骼疾病的一项指标，但最近的研究表明，在透析患者中，它可能是一个超出单纯矿物质-骨骼状态的附加指标。本研究的目的是评估血液透析（HD）患者的ALP水平以及营养不良、身体机能或住院情况的各项指标。本研究为一项观察性研究（n = 84）。我们纳入了所有符合以下标准的HD患者：年龄≥20岁，透析时间≥6个月，无需辅助设备即可行走，能够与访谈者交流，且在入组前最后3个月内未住院。此外，所有患者均无肝脏疾病。我们建议在研究期间戒酒≥1个月。根据ALP水平将患者分为三个三分位数组。评估肌肉量[使用双能X线吸收法的四肢肌肉量指数（ASM/Ht）、使用计算机断层扫描的大腿肌肉面积指数（TMA/Ht）]、力量[握力（HGS）]和身体机能[步速（GS）、30秒坐立试验（STS30）、6分钟步行试验（6-MWT）或简短身体机能量表测试（SPPB）]。还评估了住院次数。低、中、高三分位数组的ALP水平分别为50.5±7.5、69.8±5.4和113.3±47.3 IU/l。与其他三分位数组相比，高三分位数组在ASM/Ht、TMA/Ht、HGS、GS、STS30和6-MWT方面表现出最差的趋势。逻辑回归分析表明，低HGS、低GS或低SPPB的高三分位数组与其他三分位数组相比，比值比更高。根据年龄、性别和糖尿病进行的亚组分析显示出与总队列相似的趋势。高三分位数组和其他三分位数组在300天后的无住院生存率分别为53.8%和77.2%（P = 0.105）。本研究表明，ALP与维持性HD患者的肌肉量、力量和身体机能相关。此外，趋势显示低或中三分位数组的无住院生存率优于高三分位数组。ALP可被视为检测HD患者营养不良、身体机能或住院情况的一个简单且有用的指标。
