Abstract: SA-PO547
Prognostic Importance of Serum Alkaline Phosphatase in Type 2 Diabetic Patients with Diabetic Nephropathy
Session Information
- Diabetic Kidney Disease: Pathology, Epidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Zhao, Lijun, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China, Chengdu, China
- Liu, Fang, West China Hospital of Sichuan University, Chengdu, China
Background
This study was aimed to investigate the impact of circulating alkaline phosphatase (ALP) on renal outcomes in type 2 diabetic patients with diabetic nephropathy (DN).
Methods
This longitudinal observational study enrolled 299 type 2 diabetic patients with biopsy-proven diabetic nephropathy. Patients were divided into two groups: nephrotic-range proteinuria group (NPU, 24h proteinuria≥3.5 g/d, n=179), and non nephrotic-range proteinuria group (non-NPU: 24h proteinuria<3.5 g/d, n=121). Multivariable adjusted Cox models were used to estimate the association of serum ALP with end-stage renal disease (ESRD).
Results
During a median follow up of 26.0 months, 133 (44.5%) patients progressed to ESRD. The median ALP was much higher in NPU group than non-NPU group (87 IU/L vs. 76 IU/L, P=0.009). In NPU group, higher ALP levels were incrementally associated with higher risks of ESRD after adjusted for demographics, kidney functions, nutritional status and medications. The highest quartile of ALP was associated with a hazard ratio for ESRD of 3.37 [95% confidence interval (CI), 1.41-8.07] (Figure 1). Moreover, ALP level was positively correlated with proteinuria (r=0.21) and interstitial fibrosis and tubular atrophy (r=0.37). In non-NPU group, only the highest ALP quartile was associated with a hazard ratio for ESRD of 2.94 (95% CI, 1.08-9.36).
Conclusion
Elevated serum ALP was an independent predictor for time to renal events in type 2 diabetic patients with nephrotic-range proteinuria. Our findings suggested ALP might play a role in kidney fibrosis and interstitial injury. Further studies are warranted to clarify the potential mechanisms.
Model 1 *, adjusted for baseline age, gender, ethnicity, smoking, CVD morbidity, diabetic retinopathy, SBP, DM duration, hemoglobin, albumin, cholesterol, eGFR and proteinuria, Renin-angiotensin-aldosterone system inhibitor use.
Model 2 #, adjusted for covariates in model 1 plus renal pathological findings according to Renal Pathology Society system.
Model 3 †, adjusted for covariates in model 2 plus Calcium, Phosphorus, ALT, AST, γ-glutamyltransferase.
Funding
- Government Support - Non-U.S.