Serum Alkaline Phosphatase and Phosphate and Risk of Mortality and Hospitalization

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2010 Apr 10

PMID 20378645

Citations 51

Authors

Matthew Abramowitz

Paul Muntner

Maria Coco

William Southern

Irwin Lotwin

Thomas H Hostetter

Michal L Melamed

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Elevated alkaline phosphatase (AlkPhos) and phosphate levels are associated with cardiovascular morbidity and mortality in patients receiving dialysis. A retrospective cohort study was conducted to test these associations in outpatients with an estimated GFR > or =60 ml/min/1.73 m(2).

Design, Setting, Participants, & Measurements: Patients with serum AlkPhos and phosphate levels measured between 2000 and 2002 (n = 10,743) at Montefiore Medical Center (MMC) clinics were followed through September 11, 2008 (median 6.8 years). Mortality data were obtained via Social Security Administration records (n = 949 deaths). Hospitalization data were obtained from MMC records.

Results: The mean age was 51 years, 64% were women, 22% were white, 26% were non-Hispanic black, 16% were Hispanic, 13% had a diagnosis of hypertension, 9% had diabetes mellitus, and 8% had cardiovascular disease at baseline. AlkPhos and phosphate were independently associated with mortality and cardiovascular-related hospitalization after multivariable adjustment. Comparing patients in the highest (> or =104 U/L) versus lowest quartile of AlkPhos (< or =66 U/L), the adjusted hazard ratio (HR) for mortality was 1.65 (P trend across quartiles <0.001). For the highest compared with the lowest quartile of serum phosphate (> or =3.8 mg/dl versus < or =3.0 mg/dl), the adjusted HR for mortality was 1.29 (P trend across quartiles = 0.008). High AlkPhos but not phosphate levels were also associated with all-cause, infection-related, and fracture-related hospitalization.

Conclusions: Higher levels of serum AlkPhos and phosphate were associated with increased mortality and cardiovascular-related hospitalization in an inner-city clinic population. Further studies are needed to elucidate mechanisms underlying these associations.

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References

Foley R, Parfrey P, Sarnak M . Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998; 32(5 Suppl 3):S112-9. DOI: 10.1053/ajkd.1998.v32.pm9820470. View

Block G, Levin N, Port F . Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31(4):607-17. DOI: 10.1053/ajkd.1998.v31.pm9531176. View

Brauer C, Coca-Perraillon M, Cutler D, Rosen A . Incidence and mortality of hip fractures in the United States. JAMA. 2009; 302(14):1573-9. PMC: 4410861. DOI: 10.1001/jama.2009.1462. View

Dhingra R, Sullivan L, Fox C, Wang T, DAgostino Sr R, Gaziano J . Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med. 2007; 167(9):879-85. DOI: 10.1001/archinte.167.9.879. View

Buuren S, Boshuizen H, Knook D . Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999; 18(6):681-94. DOI: 10.1002/(sici)1097-0258(19990330)18:6<681::aid-sim71>3.0.co;2-r. View

Tonelli M, Curhan G, Pfeffer M, Sacks F, Thadhani R, Melamed M . Relation between alkaline phosphatase, serum phosphate, and all-cause or cardiovascular mortality. Circulation. 2009; 120(18):1784-92. DOI: 10.1161/CIRCULATIONAHA.109.851873. View

Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G . Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005; 112(17):2627-33. DOI: 10.1161/CIRCULATIONAHA.105.553198. View

Blacher J, Guerin A, Pannier B, Marchais S, London G . Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001; 38(4):938-42. DOI: 10.1161/hy1001.096358. View

Baxter N, Habermann E, Tepper J, Durham S, Virnig B . Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005; 294(20):2587-93. DOI: 10.1001/jama.294.20.2587. View

10.

Bagger Y, Tanko L, Alexandersen P, Qin G, Christiansen C . Radiographic measure of aorta calcification is a site-specific predictor of bone loss and fracture risk at the hip. J Intern Med. 2006; 259(6):598-605. DOI: 10.1111/j.1365-2796.2006.01640.x. View

11.

Melamed M, Eustace J, Plantinga L, Jaar B, Fink N, Coresh J . Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study. Kidney Int. 2006; 70(2):351-7. DOI: 10.1038/sj.ki.5001542. View

12.

Schulz E, Arfai K, Liu X, Sayre J, Gilsanz V . Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab. 2004; 89(9):4246-53. DOI: 10.1210/jc.2003-030964. View

13.

Cowper D, Kubal J, Maynard C, Hynes D . A primer and comparative review of major US mortality databases. Ann Epidemiol. 2002; 12(7):462-8. DOI: 10.1016/s1047-2797(01)00285-x. View

14.

Steitz S, Speer M, Curinga G, Yang H, Haynes P, Aebersold R . Smooth muscle cell phenotypic transition associated with calcification: upregulation of Cbfa1 and downregulation of smooth muscle lineage markers. Circ Res. 2001; 89(12):1147-54. DOI: 10.1161/hh2401.101070. View

15.

Dominici F, Peng R, Bell M, Pham L, McDermott A, Zeger S . Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA. 2006; 295(10):1127-34. PMC: 3543154. DOI: 10.1001/jama.295.10.1127. View

16.

Block G, Klassen P, Lazarus J, Ofsthun N, Lowrie E, Chertow G . Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208-18. DOI: 10.1097/01.ASN.0000133041.27682.A2. View

17.

Plantinga L, Fink N, Melamed M, Briggs W, Powe N, Jaar B . Serum phosphate levels and risk of infection in incident dialysis patients. Clin J Am Soc Nephrol. 2008; 3(5):1398-406. PMC: 2518791. DOI: 10.2215/CJN.00420108. View

18.

Shantouf R, Kovesdy C, Kim Y, Ahmadi N, Luna A, Luna C . Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2009; 4(6):1106-14. PMC: 2689878. DOI: 10.2215/CJN.06091108. View

19.

Iba K, Takada J, Yamashita T . The serum level of bone-specific alkaline phosphatase activity is associated with aortic calcification in osteoporosis patients. J Bone Miner Metab. 2004; 22(6):594-6. DOI: 10.1007/s00774-004-0528-9. View

20.

Detrano R, Guerci A, Carr J, Bild D, Burke G, Folsom A . Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358(13):1336-45. DOI: 10.1056/NEJMoa072100. View