Abstract: TH-PO157
Serum Alkaline Phosphatase Is Associated with Mortality and the Incidence of Hip Fracture in Patients on Dialysis: A Nationwide Cohort Study in Japan
Session Information
- CKD-MBD: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Maruyama, Yukio, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
- Nakashima, Akio, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
- Abe, Masanori, Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan
- Hanafusa, Norio, Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
- Nakai, Shigeru, Department of Clinical Engineering, Fujita Health University, Aichi, Japan
- Yokoo, Takashi, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
Background
The monitoring of serum alkaline phosphatase (ALP) is recommended in the management of chronic kidney disease-mineral bone disorder (CKD-MBD) because of its association to poor outcome among dialysis patients. However, this association is thought to be changed due to several advances in the management for CKD-MBD in the decade.
Methods
Baseline data of 241,670 dialysis patients (age, 69 ± 12 years; male, 65.9%; median dialysis duration, 68 months) were extracted from a nationwide dialysis registry in Japan at the end of 2019. Outcomes, including all-cause mortality (ACM), cardiovascular mortality (CVM) and the hip fracture, were then evaluated using the registry at the end of 2020 and 2021. ACM was assessed using Cox regression analysis, whereas CVM and incidence of hip fracture were assessed using competing-risks regression analysis.
Results
Within two year, a total of 40,449 (16.7%) died, including 13,562 (5.6%) of CV deaths. Additionally, 4,136 (2.4%) suffered hip fracture. Higher serum ALP was independently associated with higher ACM, CVM and higher incidence of hip fracture, however the effect on CVM was marginal (hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.15 to 1.21, sub-HR [SHR] 1.04, 95%CI 1.002 to 1.09 and SHR 1.27, 95%CI 1.18 to 1.37, respectively). The association between serum ALP and ACM and CVM differed according to intact parathyroid hormone (PTH) levels.
Conclusion
Higher serum ALP was independently and linearly associated with higher ACM, CVM and higher incidence of hip fracture in Japanese dialysis patients. Additionally, these associations differed by intact PTH. These findings did not change, in spite of the development of the management for CKD-MBD in the decade.