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Abstract: TH-PO710

The Combined Prognostic Significance of Vascular Calcification and Alkaline Phosphatase in Patients with ESRD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Kim, Dongryul, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea (the Republic of)
  • Hwang, So yeon, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea (the Republic of)
  • Nam, YunJung, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea (the Republic of)
  • Shin, Seok Joon, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea (the Republic of)
  • Yoon, Hye Eun, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea (the Republic of)
Background

Vascular calcification (VC) is a well-known prognostic marker in patients with end-stage renal disease (ESRD), while there are conflicting results on the role of serum alkaline phosphatase (ALP) on cardiovascular event (CVE) and mortality. This study investigated whether there was a combined effect of VC and ALP on prognosis in patients with ESRD starting dialysis.

Methods

This was a retrospective cohort study including 587 incident ESRD patients from a single center. The aortic calcification index (ACI), an estimated of abdominal aortic calcification, was calculated by abdominal computed tomography as a measure of VC. Patients were stratified into four groups according to the median ACI and serum ALP value. CVE and death were assessed as study outcomes. The association of VC and ALP on composite of end-point was analyzed. The modification effect between VC and ALP on composite of end-point was determined using an interaction product term.

Results

During a median follow-up duration of 3.1 (0.02 – 12.3) years, 140 patients (23.8%) developed CVE and 130 deaths (22.1%) occurred. In the stratified analysis, patients with higher ACI and lower ALP had a greater risk of composite of end-point compared to patients with combined lower ACI and ALP group (adjusted hazard ratio, 2.04; 95% confidence interval, 1.23 – 3.38; P = 0.006), and patients with combined higher ACI and ALP had the greatest risk (adjusted hazard ratio, 2.26; 95% confidence interval, 1.05 – 3.62; P = 0.001). The interaction between ACI and ALP on CVE and mortality was statistically significant (P < 0.05).

Conclusion

In conclusion, the combined effect of VC and higher ALP was associated with greater risk of CVE and deaths in ESRD patients starting dialysis. Serum ALP amplifies the risk of CVE and deaths associated with VC in ESRD patients.