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High Alkaline Phosphatase Levels May Signal Death Risk in Dialysis Patients WASHINGTON, DC -- July 30, 2008 -- Among patients receiving dialysis for chronic kidney disease (CKD), high levels of alkaline phosphatase may signal an increased risk of death, reports a study in the November 2008 issue of the Journal of the American Society of Nephrology. "This large epidemiologic study shows, for the first time, a consistent and robust association between a high blood level of alkaline phosphatase and cardiovascular death in thousands of dialysis patients across the United States, said coauthor Kamyar Kalantar-Zadeh, MD, University of California, Los Angeles, Los Angeles, California. "If the association between alkaline phosphatase and mortality has a causal link, treatment strategies that reduce alkaline phosphatase levels may improve survival in patients with CKD, and probably in many other patients with chronic diseases and active bone disorders." The researchers analysed data on nearly 74,000 haemodialysis patients in DaVita Dialysis Clinics during a 3-year period. Laboratory measurements of alkaline phosphatase levels were analysed as a possible predictor of mortality risk. The results showed that patients with higher alkaline phosphatase levels were at higher risk of death during the 3-year follow-up period. After adjustment for a wide range of other risk factors, patients with alkaline phosphatase levels above the upper limit of normal (>120 IU/L) had a 25% increase in mortality rate. The link between alkaline phosphatase and mortality was significant across various subgroups of dialysis patients. This included patients without hepatitis or other liver diseases and patients who had normal serum liver function or normal nutritional status, as reflected by normal serum albumin levels. In addition, patients whose alkaline phosphatase level increased during the first 6 months of the study were at higher risk of death during the subsequent 2.5 years. "In dialysis patients, increased levels of alkaline phosphatase in the blood indicate a so-called high-turnover bone disease, which can happen due to hormonal imbalance in CKD," said Dr. Kalantar-Zadeh. "For the ultimate proof of causation, treatment trials are needed to target high-turnover bone diseases to reduce serum alkaline phosphatase effectively, and then to ascertain whether these interventions can improve survival." SOURCE: American Society of Nephrology E-mail this page to a friend or colleague! To print, use this version