Serum alkaline phosphatase and phosphate and risk of mortality and hospitalization

Matthew K. Abramowitz, Paul Muntner, Maria Coco, William N. Southern, Irwin Lotwin, Thomas H. Hostetter, Michal L. Melamed

Research output: Contribution to journalArticle

66 Citations (Scopus)

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 ≥60 ml/min/1.73 m<sup>2</sup>. 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 (≥104 U/L) versus lowest quartile of AlkPhos (≤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 (≥3.8 mg/dl versus ≤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.

Original languageEnglish (US)
Pages (from-to)1064-1071
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume5
Issue number6
DOIs
StatePublished - Jun 1 2010

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Alkaline Phosphatase
Hospitalization
Phosphates
Mortality
Serum
United States Social Security Administration
Hispanic Americans
Medical Records
Dialysis
Diabetes Mellitus
Cohort Studies
Outpatients
Cardiovascular Diseases
Retrospective Studies
Hypertension
Morbidity
Infection
Population

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Serum alkaline phosphatase and phosphate and risk of mortality and hospitalization. / Abramowitz, Matthew K.; Muntner, Paul; Coco, Maria; Southern, William N.; Lotwin, Irwin; Hostetter, Thomas H.; Melamed, Michal L.

In: Clinical Journal of the American Society of Nephrology, Vol. 5, No. 6, 01.06.2010, p. 1064-1071.

Research output: Contribution to journalArticle

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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 ≥60 ml/min/1.73 m2. 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 (≥104 U/L) versus lowest quartile of AlkPhos (≤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 (≥3.8 mg/dl versus ≤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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