Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

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An association between time-varying serum alkaline phosphatase concentrations and mortality rate in patients undergoing peritoneal dialysis: a five-year cohort study

Scientific Reports ◽

10.1038/srep43314 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 7

Author(s):

Ying Liu ◽

Jin-Gang Zhu ◽

Ben-Chung Cheng ◽

Shang-Chih Liao ◽

Chih-Hsiung Lee ◽

...

Keyword(s):

Cardiovascular Disease ◽

Alkaline Phosphatase ◽

Peritoneal Dialysis ◽

Serum Alkaline Phosphatase ◽

Urine Volume ◽

Time Dependent ◽

Time Varying ◽

Cox Models ◽

Death Risk ◽

The Relationship

Abstract The relationship between serum alkaline phosphatase (ALP) concentrations and mortality in peritoneal dialysis (PD) patients is rarely reported. We enrolled 667 PD patients in one PD centre in Taiwan to retrospectively examine the association between three ALP concentrations (baseline, time-averaged, time-dependent) and mortality over a 5-year period (2011–2015). Baseline data collection included demographics, clinical, and laboratory parameters. Multivariable-adjusted Cox models were used to analyse the association. Four ALP quartiles were defined at the baseline: ≤62, 63–82, 83–118, and ≥119 U/L. Of 667 patients, 65 patients died, of which 8 patients died due to cardiovascular disease. Females were predominant in the higher ALP quartiles, and 24-h urine volume was significantly proportionately decreased in the higher ALP quartiles. ALP quartiles expressed by the three models were not associated with all-cause or cardiovascular mortalities after adjusting for demographics, liver function, bone metabolism, mortality, hemoglobin, and 24-h urine volume. In conclusion, ALP concentrations were not associated with death risk in PD patients over the 5-year period.

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Racial and Ethnic Differences in Mortality Associated with Serum Potassium in Incident Peritoneal Dialysis Patients

American Journal of Nephrology ◽

10.1159/000502998 ◽

2019 ◽

Vol 50 (5) ◽

pp. 361-369 ◽

Cited By ~ 1

Author(s):

Rieko Eriguchi ◽

Yoshitsugu Obi ◽

Melissa Soohoo ◽

Connie M. Rhee ◽

Csaba P. Kovesdy ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Potassium ◽

Dialysis Patients ◽

Cox Models ◽

Baseline Serum ◽

Racial And Ethnic Differences ◽

Hispanic Patients ◽

Race Ethnicity ◽

The Relationship ◽

Related Mortality

Background: Abnormalities in serum potassium are risk factors for sudden cardiac death and arrhythmias among dialysis patients. Although a previous study in hemodialysis patients has shown that race/ethnicity may impact the relationship between serum potassium and mortality, the relationship remains unclear among peritoneal dialysis (PD) patients where the dynamics of serum potassium is more stable. Methods: Among 17,664 patients who started PD between January 1, 2007 and December 31, 2011 in a large US dialysis organization, we evaluated the association of serum potassium levels with all-cause and arrhythmia-related deaths across race/ethnicity using time-dependent Cox models with adjustments for demographics. We also used restricted cubic spline functions for serum potassium levels to explore non-linear associations. Results: Baseline serum potassium levels were the highest among Hispanics (4.2 ± 0.7 mEq/L) and lowest among non-Hispanic blacks (4.0 ± 0.7 mEq/L). Among 2,949 deaths during the follow-up of median 2.2 (interquartile ranges 1.3–3.2) years, 683 (23%) were arrhythmia-related deaths. Overall, both hyperkalemia and hypokalemia (i.e., serum potassium levels >5.0 and <3.5 mEq/L, respectively) were associated with higher all-cause and arrhythmia-related mortality. In a stratified analysis according to race/ethnicity, the association of hypokalemia with all-cause and arrhythmia-related mortality was consistent with an attenuation for arrhythmia-related mortality in non-Hispanic blacks. Hyperkalemia was associated with all-cause and arrhythmia-related mortality in non-Hispanic whites and non-Hispanic blacks, but no association was observed in Hispanics. Conclusion: Among incident PD patients, hypokalemia was consistently associated with all-cause and arrhythmia-related deaths irrespective of race/ethnicity. However, while hyperkalemia was associated with both death outcomes in non-Hispanic blacks and whites, it was not associated with either death outcome in Hispanic patients. Further studies are needed to demonstrate whether different strategies should be followed for the management of serum potassium levels according to race/ethnicity.

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Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfr070 ◽

2011 ◽

Vol 26 (10) ◽

pp. 3366-3372 ◽

Cited By ~ 35

Author(s):

W. H. Lim ◽

N. Boudville ◽

S. P. McDonald ◽

G. Gorham ◽

D. W. Johnson ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Patients ◽

Technique Failure ◽

Related Mortality

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MP502DOES ALKALINE PHOSPHATASE CORRELATE WITH CARDIOVASCULAR CALCIFICATION IN PERITONEAL DIALYSIS PATIENTS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw195.18 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i507-i507

Author(s):

Saimir Seferi ◽

Merita Rroji ◽

Erjola Likaj ◽

Myftar Barbullushi ◽

Matilda Imeraj ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Peritoneal Dialysis ◽

Dialysis Patients

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Comparative Mortality–Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00110 ◽

2014 ◽

Vol 34 (7) ◽

pp. 732-748 ◽

Cited By ~ 17

Author(s):

Connie M. Rhee ◽

Miklos Z. Molnar ◽

Wei Ling Lau ◽

Vanessa Ravel ◽

Csaba P. Kovesdy ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Peritoneal Dialysis ◽

Parathyroid Hormone ◽

Serum Alkaline Phosphatase ◽

Reference Ranges ◽

Cox Models ◽

Death Risk ◽

Entry Period ◽

Hazard Ratios

BackgroundIn hemodialysis (HD) patients, serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) derangements are associated with mortality, but outcome-predictability using ALP and PTH in peritoneal dialysis (PD) patients remains uncertain.MethodsIn a cohort of 9244 adult PD patients from a large national dialysis organization (entry period 2001 – 2006, with follow-up through 2009), we used multivariable Cox models adjusted for case-mix and laboratory covariates to examine the associations of time-averaged ALP and PTH with all-cause mortality. We then compared mortality-predictability using ALP and PTH in 9244 PD and 99 323 HD patients.ResultsIn PD patients, ALP concentrations exceeding 150 U/L were associated with increased mortality (reference ALP: 70 to <90 U/L). Hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.18 (1.03 to 1.36), 1.27 (1.08 to 1.50), 1.49 (1.23 to 1.79), and 1.35 (1.19 to 1.53) for ALP concentrations of 150 to <170 U/L, 170 to <190 U/L, 190 to <210 U/L, and ≥210 U/L respectively. In contrast, we observed a U-shaped association between PTH concentration and death risk in PD patients, with PTH concentrations of less than 200 pg/mL and 700 pg/mL or more associated with increased mortality (reference PTH: 200 to <300 pg/mL). Hazard ratios and 95% CIs were 1.25 (1.12 to 1.41), 1.12 (1.02 to 1.23), 1.06 (0.96 to 1.18), 1.09 (0.97 to 1.24), 1.12 (0.97 to 1.29), 1.18 (0.99 to 1.40), and 1.23 (1.09 to 1.38) for PTH concentrations of <100 pg/mL, 100 to <200 pg/mL, 300 to <400 pg/mL, 400 to <500 pg/mL, 500 to <600 pg/mL, 600 to <700 pg/mL, and ≥700 pg/mL respectively. Compared with PD patients having serum concentrations of ALP and PTH within reference ranges, patients on HD experienced increased mortality across all ALP and PTH concentrations, particularly those in the lowest and highest categories.ConclusionsIn summary, higher ALP concentrations are associated with increased mortality, and lower and higher PTH concentrations are both associated with death risk in PD patients. The utility of ALP in the management of chronic kidney disease mineral bone disorders in PD patients warrants further study.

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