Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

被引:122
|
作者
Shantouf, Ronney [1 ,2 ]
Kovesdy, Csaba P. [5 ]
Kim, Youngmee [1 ]
Ahmadi, Naser [3 ]
Luna, Amanda [1 ]
Luna, Claudia [1 ]
Rambod, Mehdi [1 ]
Nissenson, Allen R. [4 ]
Budoff, Matthew J. [2 ]
Kalantar-Zadeh, Kamyar [1 ,3 ]
机构
[1] Univ Calif Los Angeles, Med Ctr, Harold Simmons Ctr Kidney Dis Res & Epidemiol, Los Angeles Biomed Res Inst Harbor, Torrance, CA 90502 USA
[2] Univ Calif Los Angeles, Med Ctr, Div Cardiol, Los Angeles Biomed Res Inst Harbor, Torrance, CA 90502 USA
[3] Univ Calif Los Angeles, Sch Publ Hlth, Dept Epidemiol, Los Angeles, CA 90502 USA
[4] DaVita Inc, El Segundo, CA USA
[5] Salem Vet Affairs Med Ctr, Salem, VA USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2009年 / 4卷 / 06期
关键词
CHRONIC KIDNEY-DISEASE; BEAM COMPUTED-TOMOGRAPHY; VASCULAR CALCIFICATION; DIALYSIS PATIENTS; FETUIN-A; AORTIC CALCIFICATION; CLINICAL-OUTCOMES; HEART-DISEASE; RENAL-DISEASE; CALCIUM;
D O I
10.2215/CJN.06091108
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: Recent in vitro studies have shown a link between alkaline phosphatase and vascular calcification in patients with chronic kidney disease (CKD). High serum levels of alkaline phosphatase are associated with increased death risk in epidemiologic studies of maintenance hemodialysis (MHD) patients. We hypothesized that coronary artery calcification is independently associated with increased serum alkaline phosphatase levels in MHD patients. Design, setting, participants, & measurements: We examined the association of coronary artery calcification score (CACS) and alkaline phosphatase in 137 randomly selected MHD patients for whom markers of malnutrition, inflammation, and bone and mineral disorders were also measured. Results: Serum alkaline phosphatase was the only measure with significant and robust association with CACS (P < 0.003), whereas either other biochemical markers had no association with CACS or their association was eliminated after controlling for case-mix variables. Serum alkaline phosphatase >120 IU/L was a robust predictor of higher CACS and was particularly associated with the likelihood of CACS >400 (multivariate odds ratio 5.0 95% confidence interval 1.6 to 16.3; P = 0.007). Serum alkaline phosphatase of approximately 85 IU/L seemed to be associated with the lowest likelihood of severe coronary artery calcification, but in the lowest tertile of alkaline phosphatase, the CACS predictability was not statistically significant. Conclusions: An association between serum alkaline phosphatase level and CACS exists in MHD patients. Given the high burden of vascular calcification in patients with CKD, examining potential therapeutic interventions to modulate the alkaline phosphatase pathway may be warranted. Clin J Am Soc Nephrol 4: 1106-1114, 2009. doi: 10.2215/CJN.06091108
引用
收藏
页码:1106 / 1114
页数:9
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