ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO1203

Association Between Serum Alkaline Phosphatase Levels and Stroke Risk in Patients Receiving Maintenance Hemodialysis: The Q-Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Kitamura, Hiromasa, Kyushu Daigaku, Fukuoka, Fukuoka, Japan
  • Yamada, Shunsuke, Kyushu Daigaku, Fukuoka, Japan
  • Hiyamuta, Hiroto, Kyushu Daigaku, Fukuoka, Fukuoka, Japan
  • Yotsueda, Ryusuke, Munakata Medical Association Hospital, Munakata, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka, Japan
  • Tokumoto, Masanori, Fukuoka Shika Daigaku, Fukuoka, Fukuoka, Japan
  • Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan
  • Nakano, Toshiaki, Kyushu Daigaku, Fukuoka, Fukuoka, Japan
  • Kitazono, Takanari, Kyushu Daigaku, Fukuoka, Japan

Elevated serum alkaline phosphatase (ALP) levels have been associated with increased risks of all-cause and cardiovascular mortality in patients receiving hemodialysis (HD). However, little is known about the impacts of serum ALP levels on the occurrence of stroke, including brain hemorrhage and brain infarction. This study aimed to explore the association between serum ALP levels and brain hemorrhage or brain infarction separately in HD patients.


A total of 3,497 maintenance HD patients registered in the Q-Cohort Study, a multicenter observational cohort study in Japan, were examined. The primary outcomes were the first-ever incidence of either brain hemorrhage or brain infarction during the follow-up period. The covariate of interest was serum ALP levels. Patients were divided into tertiles based on the serum ALP levels at baseline [ALP (U/L): T1, <69.3; T2, 69.3–98.4; T3, >98.4]. The risks for brain hemorrhage or brain infarction were estimated using a Cox proportional hazards model and a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk. The restricted cubic spline model was used to plot the multivariable-adjusted association between serum ALP levels and hazard ratios (HRs) and 95% confidence intervals (CIs) for brain hemorrhage or brain infarction.


During the follow-up period of four years, 89 patients developed brain hemorrhage and 195 patients developed brain infarction. The risk of brain hemorrhage in the highest tertile (T3) was significantly higher than that in the lowest tertile (T1): multivariable-adjusted HR [95% CI], 1.93 [1.15–3.35], subdistribution HR, 1.91 [1.10–3.30]. Furthermore, restricted cubic spline curves showed that higher serum ALP levels were significantly and incrementally associated with an increased risk for brain hemorrhage. In contrast, no significant association was identified between serum ALP levels and the risk of brain infarction.


Higher serum ALP levels were associated with an increased risk of brain hemorrhage in patients receiving maintenance HD. Our results suggest that ALP might play some roles in the pathogenesis of brain hemorrhage in HD patients.


  • Private Foundation Support