Nutritional Status and Mortality Predictability for Time-Varying Serum Alkaline Phosphatase in Hemodialysis Patients: A Longitudinal Study

Beberashvili, Ilia; Samogalska, O. Ye.; Azar, Ada; Stav, Kobi; Efrati, Shai

doi:10.1053/j.jrn.2019.10.004

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…Similar findings were reported by Beberashvili et al who retrospectively analyzed a large clinical database of 554 HD patients, with an average age of 68 years, and an observation period up to 94 months [19]. Longitudinal changes in ALP as well as other bone turnover, nutritional or inflammatory markers were assessed at baseline and after 6, 12, 18, 24, 30 and 36 months.…”

Section: Discussionsupporting

confidence: 77%

Serum alkaline phosphatase is a strong predictor of mortality in ESKD patients: analysis of the RISCAVID cohort

Panichi,

Rosati,

Mangione

et al. 2024

J Nephrol

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Background Mortality in hemodialysis (HD) patients remains unacceptably high compared with that of the general population and despite the continuous improvement of dialysis techniques. This study aimed to assess the role of alkaline phosphatase serum levels on cardiovascular and overall mortality in the RISCAVID study cohort through a long follow-up period, looking for associations with known risk factors for poor outcome. Methods In June 2004, a prospective observational study was started focusing on the cardiovascular risk in hemodialysis patients who lived in the north-west area of Tuscany (RISCAVID, “RISchio CArdiovascolare nei pazienti afferenti all’Area Vasta In Dialisi”). The RISCAVID cohort included 572 prevalent patients on maintenance HD for at least three months. Morbid or fatal events were prospectively recorded at 6-month intervals for a follow up time of 216 months. Results In univariable Cox regression analysis, dialysis technique, Geriatric Nutritional Risk Index, peripheral vascular disease, and intact parathyroid hormone and total calcium serum levels were significantly associated with baseline alkaline phosphatase serum levels. Cox multivariable analysis showed that elevated serum alkaline phosphatase levels (the highest quartile), advanced age, dialysis vintage, type of vascular access, Geriatric Nutritional Risk Index, C-reactive protein and calcium serum levels, history of cardiovascular disease and peripheral vascular disease were independent predictors of overall mortality in maintenance HD patients. The fourth quartile of alkaline phosphatase was associated with all-cause 10-year mortality (HR: 1.47; 95% CI: 1.177–1.834) with a 47% increase with respect to the 1st, 2nd, and 3rd quartiles. This was also observed for 18-year all-cause mortality. Conclusions Adjusted proportional analysis showed the alkaline phosphatase value to be an independent and powerful predictor of overall mortality in the hemodialysis population. Graphical Abstract

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Section: Discussionsupporting

confidence: 77%

Serum alkaline phosphatase is a strong predictor of mortality in ESKD patients: analysis of the RISCAVID cohort

Panichi,

Rosati,

Mangione

et al. 2024

J Nephrol

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“…Kim et al investigated the association between ALP level and increased fat in the general population (9). Beberashvili et al performed a longitudinal study and showed the positive association between ALP level and nutritional or inflammatory indicators beyond simple CKD-MBD markers (25). These two studies hypothesized the relationship between ALP and inflammation.…”

Section: Discussionmentioning

confidence: 99%

Association Between Alkaline Phosphatase and Muscle Mass, Strength, or Physical Performance in Patients on Maintenance Hemodialysis

2021

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Introduction: Alkaline phosphatase (ALP) is an indicator for checking liver or bone disorders, but recent studies have shown the possibility of an additive indicator beyond the simple mineral-bone status in dialysis patients. The aim of the study was to evaluate the ALP level and various indicators for malnutrition, physical performance, or hospitalization in patients on hemodialysis (HD).Methods: This study was an observational study (n = 84). We included all patients undergoing HD with the following criteria: age ≥ 20 years, duration of dialysis ≥ 6 months, ability to ambulate without an assistive device, ability to communicate with the interviewer, and no hospitalization within the last 3 months before enrollment. Furthermore, none of the patients had liver disease. We recommended abstinence of alcohol for ≥ 1 month for the duration of the study. The patients were divided into tertiles based on the ALP level. Muscle mass [appendicular muscle mass index using dual-energy X-ray absorptiometry (ASM/Ht2), thigh muscle area index using computed tomography (TMA/Ht2)], strength [handgrip strength (HGS)], and physical performance [gait speed (GS), sit-to-stand for 30-s test (STS30), 6-min walk test (6-MWT), or Short Physical Performance Battery test (SPPB)] were evaluated. The number of hospitalizations was also evaluated.Results: The ALP level in the low, middle, and high tertiles was 50.5 ± 7.5, 69.8 ± 5.4, and 113.3 ± 47.3 IU/l, respectively. The high tertile group showed the poorest trends in ASM/Ht2, TMA/Ht2, HGS, GS, STS30, and 6-MWT compared to the other tertile groups. Logistic regression analysis showed that the high tertile group for low HGS, low GS, or low SPPB had a higher odds ratio compared to the other tertiles. Subgroup analyses according to age, sex and diabetes mellitus showed similar trends as in the total cohort. Hospitalization-free survival rates after 300 days in the high tertile and the other tertiles were 53.8 and 77.2%, respectively (P = 0.105).Conclusion: The present study demonstrated that ALP is associated with muscle mass, strength, and physical performance in patients on maintenance HD. In addition, the trend showed better hospitalization-free survival in the low or middle tertiles than in the high tertile. ALP can be considered as a simple and useful indicator to detect malnutrition, physical performance, or hospitalization in patients on HD.

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“…Murtas et al 26 studied the loss of arterial blood concentration of nonessential, essential, and branched-chain amino acids comparing on-line modern high-efficiency hemodialysis and hemodiafiltration in 10 patients who were randomized to these modalities and reported a reduction of essential and nonessential amino acids, which after 12 months led to progressive deterioration of lean mass and emergence of sarcopenia. Hence, it is possible that amino acid supplementation may be needed to prevent hypercatabolism and cachexia.…”

mentioning

confidence: 99%

“…Hence, it is possible that amino acid supplementation may be needed to prevent hypercatabolism and cachexia. 26 Beberashvili et al 27 examined the mortality-predictability of time-varying serum alkaline phosphatase in 554 patients on hemodialysis over time and found that longitudinally increasing levels of serum alkaline phosphatase was associated with improved nutritional status and lower mortality.…”

mentioning

confidence: 99%

Precision Nutrition and Personalized Diet Plan for Kidney Health and Kidney Disease Management

Kalantar-Zadeh

Moore

2020

Journal of Renal Nutrition

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Nutritional Status and Mortality Predictability for Time-Varying Serum Alkaline Phosphatase in Hemodialysis Patients: A Longitudinal Study

Cited by 6 publications

References 39 publications

Serum alkaline phosphatase is a strong predictor of mortality in ESKD patients: analysis of the RISCAVID cohort

Serum alkaline phosphatase is a strong predictor of mortality in ESKD patients: analysis of the RISCAVID cohort

Association Between Alkaline Phosphatase and Muscle Mass, Strength, or Physical Performance in Patients on Maintenance Hemodialysis

Precision Nutrition and Personalized Diet Plan for Kidney Health and Kidney Disease Management

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