Analysis Of All-Cause Mortality In Patients With Serum Alkaline Phosphatase And Peritoneal Dialysis Based On Residual Renal Function

Objective:Increased serum alkaline phosphatase(ALP)is predictive of a higher mortality in patients with end-stage renal disease.However,it remains unknown whether residual renal function(RRF)influences the outcome-association of serum ALP among peritoneal dialysis(PD)patients.We conducted this study to explore the association between serum ALP and all-cause mortality based on residual renal function.Methods:As a single-center retrospective cohort study,all incident PD patients who were catheterized at The First Affiliated Hospital of Nanchang University fromNovember1,2005 to February 28,2017 PD Patients were included.These patients were divided into groups with and without RRF(RRF and Non-RRF groups)and those with serum ALP levels in tertiles.The Kaplan-Meier method and multivariate Cox proportional hazard models were used to analyze their outcomes based on RRF and serum ALP levels.Results:These 650 patients had a mean age of 49.4 ± 14.0 years old,with 56.6% male,19.1% and 11.2% had diabetes and cardiovascular diseases,respectively.PD patients' median ALP level was 74 U/L(interquartile range [IQR]: 59-98).After 28-month(interquartile range [IQR]: 14-41)follow-up,80(17.4%)patients in RRF group and40(21.2%)patients in non-RRF group died.PD patients with the highest serum ALP tertile had significantly lower survival(P=0.014)when compared to other patients in the RRF group.However,this relationship was not observed in patients in the non-RRF group(P=0.296).After multivariate adjustment,in the RRF group,patients with the highest ALP tertile had a significantly higher risk of mortality(hazard ratio[HR]: 2.26,95% confidence interval [CI]: 1.06-4.82,P=0.034).Each 10-U/L increase in ALP level was associated with a 4%(HR: 1.04,95% CI: 1.00-1.08,P=0.045)higher mortality risk.These results suggest that serum ALP levels were not associated with mortality in models 1-3 in the non-RRF group.Conclusion:The relationship between serum ALP and all-cause mortality could be modified by RRF among PD patients,and that higher serum ALP levels are correlated with increased all-cause mortality solely in patients with RRF.