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Total and bone-specific alkaline phosphatase are associated with bone mineral density over time in end-stage renal disease patients starting dialysis

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Abstract

Background

Alkaline phosphatase (ALP) and bone-specific ALP (BALP) are implicated in the abnormal skeletal mineralization and accelerated vascular calcification in chronic kidney disease (CKD) patients. Whereas ALP and BALP may predict mortality in CKD, BALP is reported to have higher sensitivity and specificity than total ALP in reflecting histological alterations in bone; however, results on their associations with bone mineral density (BMD) are inconsistent. Here we evaluated associations of total ALP and BALP with BMD during up to 24 months in end-stage renal disease (ESRD) patients.

Methods

In this longitudinal study, 194 ESRD patients (median age 57 years, 66 % male, 32 % diabetes mellitus, mean body mass index 24.8 kg/m2) underwent measurements of total ALP and BALP and total and regional body BMD (by dual-energy X-ray absorptiometry) at dialysis initiation (n = 194), and after 12 (n = 98) and 24 months (n = 40) on dialysis.

Results

At baseline, patients had median total ALP 65.4 (43.3–126.4) U/l, BALP 13.5 (7.1–27.3) µg/l and BMD 1.14 (0.97–1.31) g/cm2. During the study period, serum concentrations of ALP and BALP increased significantly (p < 0.001), whereas total and regional BMD remained stable. BMD correlated inversely with total ALP (rho = −0.20, p = 0.005) and BALP (rho = −0.30, p < 0.001) at baseline, and correlations were similar also at 12 and 24 months.

Conclusion

ALP and BALP are equally accurate albeit weak predictors of BMD in ESRD patients, both at baseline and longitudinally. The dissociation between stable BMD and increasing ALP and BALP may possibly reflect increased soft tissue calcifications with time on dialysis.

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Acknowledgments

We are grateful to the patients participating in the study. We thank Annika Nilsson, Anki Emmoth, Ulrika Jensen and Åsa Lindé for collection of samples, and Ann-Christin Bragfors-Helin and Monica Eriksson for laboratory analyses. This study was presented in part as a poster in abstract form at the 51th Congress of ERA EDTA in Amsterdam, June 2014. Baxter Novum is the result of a grant from Baxter Healthcare Corporation to Karolinska Institutet.

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Authors and Affiliations

  1. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden

    Annelie Bergman, Abdul Rashid Qureshi, Mathias Haarhaus, Bengt Lindholm, Peter Barany, Olof Heimburger, Peter Stenvinkel & Björn Anderstam

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  1. Annelie Bergman
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  2. Abdul Rashid Qureshi
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  3. Mathias Haarhaus
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  4. Bengt Lindholm
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  6. Olof Heimburger
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  7. Peter Stenvinkel
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Correspondence to Björn Anderstam.

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Conflicts of interest

B. Lindholm is affiliated with Baxter Healthcare Corporation. None of the other authors declare any conflict of interest.

Ethical approval

The Ethics Committee of the Karolinska Institutet approved the study and the procedures followed were in accordance with the Helsinki Declaration.

Informed consent

Informed consent was obtained from each patient.

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Bergman, A., Qureshi, A.R., Haarhaus, M. et al. Total and bone-specific alkaline phosphatase are associated with bone mineral density over time in end-stage renal disease patients starting dialysis. J Nephrol 30, 255–262 (2017). https://doi.org/10.1007/s40620-016-0292-7

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