BACKGROUND AND OBJECTIVES: Higher serum total alkaline phosphatase (AP) levels are associated with increased serum C-reactive protein (CRP) levels and mortality in the general and CKD populations. It is unclear to what extent these associations are related to bone disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a nationally representative sample of 10,707 adult participants from the 1999-2004 National Health and Nutrition Examination Survey, serum nonskeletal AP levels were estimated from the measured serum skeletal and total AP levels. The associations of serum skeletal AP and nonskeletal AP levels with elevated serum CRP concentrations (>3 mg/L) and mortality were examined in multivariable models. RESULTS: Skeletal AP was not associated with elevated CRP (for each doubling in non-CKD: odds ratio [OR], 1.00; 95% confidence interval [95% CI], 0.90-1.11; in CKD: OR, 1.19; 95% CI, 0.83-1.70) or mortality (for each doubling in non-CKD: hazard ratio [HR], 1.10; 95% CI, 0.94-1.29; in CKD: HR, 0.98; 95% CI, 0.75-1.28). In contrast, nonskeletal AP was associated with elevated CRP (for each doubling in non-CKD: OR, 4.51; 95% CI, 3.80-5.35; in CKD: OR, 5.98; 95% CI, 3.40-10.51). Nonskeletal AP was associated with mortality in non-CKD (for each doubling: HR, 1.96; 95% CI, 1.37-2.80) but not in CKD (for each doubling: HR, 0.92; 95% CI, 0.51-1.67) (interaction P=0.03). CONCLUSIONS: Bone disease is unlikely to account for the known associations of serum total AP with increased inflammation and mortality.
BACKGROUND AND OBJECTIVES: Higher serum total alkaline phosphatase (AP) levels are associated with increased serum C-reactive protein (CRP) levels and mortality in the general and CKD populations. It is unclear to what extent these associations are related to bone disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a nationally representative sample of 10,707 adult participants from the 1999-2004 National Health and Nutrition Examination Survey, serum nonskeletal AP levels were estimated from the measured serum skeletal and total AP levels. The associations of serum skeletal AP and nonskeletal AP levels with elevated serum CRP concentrations (>3 mg/L) and mortality were examined in multivariable models. RESULTS: Skeletal AP was not associated with elevated CRP (for each doubling in non-CKD: odds ratio [OR], 1.00; 95% confidence interval [95% CI], 0.90-1.11; in CKD: OR, 1.19; 95% CI, 0.83-1.70) or mortality (for each doubling in non-CKD: hazard ratio [HR], 1.10; 95% CI, 0.94-1.29; in CKD: HR, 0.98; 95% CI, 0.75-1.28). In contrast, nonskeletal AP was associated with elevated CRP (for each doubling in non-CKD: OR, 4.51; 95% CI, 3.80-5.35; in CKD: OR, 5.98; 95% CI, 3.40-10.51). Nonskeletal AP was associated with mortality in non-CKD (for each doubling: HR, 1.96; 95% CI, 1.37-2.80) but not in CKD (for each doubling: HR, 0.92; 95% CI, 0.51-1.67) (interaction P=0.03). CONCLUSIONS:Bone disease is unlikely to account for the known associations of serum total AP with increased inflammation and mortality.
Authors: Margaret J Blayney; Ronald L Pisoni; Jennifer L Bragg-Gresham; Juergen Bommer; Luis Piera; Akira Saito; Takashi Akiba; Marcia L Keen; Eric W Young; Friedrich K Port Journal: Kidney Int Date: 2008-06-11 Impact factor: 10.612
Authors: K Kalantar-Zadeh; N Kuwae; D L Regidor; C P Kovesdy; R D Kilpatrick; C S Shinaberger; C J McAllister; M J Budoff; I B Salusky; J D Kopple Journal: Kidney Int Date: 2006-07-05 Impact factor: 10.612
Authors: Matthew Abramowitz; Paul Muntner; Maria Coco; William Southern; Irwin Lotwin; Thomas H Hostetter; Michal L Melamed Journal: Clin J Am Soc Nephrol Date: 2010-04-08 Impact factor: 8.237
Authors: Deborah L Regidor; Csaba P Kovesdy; Rajnish Mehrotra; Mehdi Rambod; Jennie Jing; Charles J McAllister; David Van Wyck; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: J Am Soc Nephrol Date: 2008-07-30 Impact factor: 10.121
Authors: Marcello Tonelli; Gary Curhan; Marc Pfeffer; Frank Sacks; Ravi Thadhani; Michal L Melamed; Natasha Wiebe; Paul Muntner Journal: Circulation Date: 2009-10-19 Impact factor: 29.690
Authors: Bernard M Y Cheung; Kwok Leung Ong; Roberta V Cheung; Louisa Y F Wong; Nelson M S Wat; Sidney Tam; Gabriel M Leung; Chun Ho Cheng; Jean Woo; Edward D Janus; Chu Pak Lau; Tai Hing Lam; Karen S L Lam Journal: Clin Chem Lab Med Date: 2008 Impact factor: 3.694
Authors: D L Broyles; R G Nielsen; E M Bussett; W D Lu; I A Mizrahi; P A Nunnelly; T A Ngo; J Noell; R H Christenson; B C Kress Journal: Clin Chem Date: 1998-10 Impact factor: 8.327
Authors: Jonathan J Taliercio; Jesse D Schold; James F Simon; Susana Arrigain; Anne Tang; Georges Saab; Joseph V Nally; Sankar D Navaneethan Journal: Am J Kidney Dis Date: 2013-06-12 Impact factor: 8.860
Authors: Timothy Ellam; James Fotheringham; Martin E Wilkie; Sheila E Francis; Timothy J A Chico Journal: PLoS One Date: 2014-02-05 Impact factor: 3.240