BACKGROUND: Abnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages. METHODS: We examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥ 75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models. RESULTS: Higher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥ 45 years). Compared with patients with serum PTH 150 to <300 pg/mL, the death risks were higher in patients with serum PTH 300 to <600 pg/mL [HRs (95% CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥ 75 years, respectively], and ≥ 600 pg/mL [HRs(95% CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥ 75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years. CONCLUSIONS: There are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels.
BACKGROUND: Abnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages. METHODS: We examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥ 75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models. RESULTS: Higher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥ 45 years). Compared with patients with serum PTH 150 to <300 pg/mL, the death risks were higher in patients with serum PTH 300 to <600 pg/mL [HRs (95% CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥ 75 years, respectively], and ≥ 600 pg/mL [HRs(95% CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥ 75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years. CONCLUSIONS: There are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels.
Entities:
Keywords:
age; alkaline phosphatase; bone turnover markers; hemodialysis; parathyroid hormone
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: 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: Emil Hagström; Per Hellman; Tobias E Larsson; Erik Ingelsson; Lars Berglund; Johan Sundström; Håkan Melhus; Claes Held; Lars Lind; Karl Michaëlsson; Johan Arnlöv Journal: Circulation Date: 2009-05-18 Impact factor: 29.690
Authors: Grasiele E Crippa; Marcio M Beloti; Cristina R Cardoso; João S Silva; Adalberto L Rosa Journal: J Cell Biochem Date: 2008-05-15 Impact factor: 4.429
Authors: Francesca Tentori; Margaret J Blayney; Justin M Albert; Brenda W Gillespie; Peter G Kerr; Jürgen Bommer; Eric W Young; Tadao Akizawa; Takashi Akiba; Ronald L Pisoni; Bruce M Robinson; Friedrich K Port Journal: Am J Kidney Dis Date: 2008-06-02 Impact factor: 8.860
Authors: Sonoko Narisawa; Dympna Harmey; Manisha C Yadav; W Charles O'Neill; Marc F Hoylaerts; Jose Luis Millán Journal: J Bone Miner Res Date: 2007-11 Impact factor: 6.741
Authors: R J M W Rennenberg; A G H Kessels; L J Schurgers; J M A van Engelshoven; P W de Leeuw; A A Kroon Journal: Vasc Health Risk Manag Date: 2009-04-08
Authors: Oliver Malle; Markus Bergthaler; Peter Krisper; Karin Amrein; Hans Peter Dimai; Alexander H Kirsch; Alexander R Rosenkranz; Thomas Pieber; Barbara Obermayer-Pietsch; Astrid Fahrleitner-Pammer Journal: Wien Klin Wochenschr Date: 2022-03-09 Impact factor: 2.275
Authors: Mariano Rodriguez; M Dolores Salmeron; Alejandro Martin-Malo; Carlo Barbieri; Flavio Mari; Rafael I Molina; Pedro Costa; Pedro Aljama Journal: PLoS One Date: 2016-01-25 Impact factor: 3.240