Abstract: FR-PO1153
Integrating Inflammation, Quantitative Ultrasonography, and Alkaline Phosphatase for Mortality Prediction in CKD
Session Information
- CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Cohen-Hagai, Keren, Meir Medical Center, Kefar Sava, Center District, Israel
- Arbib, Nissim, Meir Medical Center, Kefar Sava, Center District, Israel
- Einbinder, Yael, Meir Medical Center, Kefar Sava, Center District, Israel
- Shashar, Moshe, Laniado Hospital, Netanya, Center District, Israel
- Grupper, Ayelet, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Tel Aviv District, Israel
- Nacasch, Naomi, Meir Medical Center, Kefar Sava, Center District, Israel
- Kalantar-Zadeh, Kamyar, The Lundquist Institute, Torrance, California, United States
Background
Alkaline phosphatase(ALP) and C-reactive protein(CRP) are commonly measured biomarkers linked to adverse outcomes in chronic kidney disease(CKD). ALP is associated with bone turnover,vascular calcification, and cardiovascular mortality ;CRP,a marker of systemic inflammation, predicts mortality in CKD. Speed of Sound(SOS), measured by quantitative ultrasound(QUS), assesses bone quality and reflects renal osteodystrophy. Together, these markers capture interconnected processes, bone-mineral disorders, inflammation, and vascular calcification, that elevate mortality risk in CKD
Methods
In this study, CKD patients underwent bone assessment using QUS to measure SOS, along with simultaneous blood measurements of ALP and CRP. Patients were followed for 5years to evaluate all-cause mortality. A composite risk score was developed by assigning 0–2 points to each biomarker based on tertile distribution:0 points for the highest SOS tertile(representing better bone quality) and lowest tertiles of ALP and CRP. The total score ranged from 0 to 6. Cox proportional hazards models was used to assess the association between this risk score and mortality, adjusting for demographics and heart failure
Results
This study included 99 patients(10 with CKD stages4–5, 89 on dialysis), with a mean age of 70.4 years (SD ±16.9). There were no significant differences in comorbidities across the SOS values.
Mortality rates significantly increased with higher risk scores(66.7%–78.9%) compared to lower scores (27.8%–28.6%, p=0.040). Cox analysis showed that rising risk scores were independently associated with higher mortality (HR 1.69–3.95, p=0.04), Figure 1
Conclusion
The integration of ALP, CRP and SOS into this risk score can effectively predict mortality in advanced CKD. SOS, CRP, and ALP reflect vascular calcification, inflammation and renal osteodystrophy, all of which significantly contribute to increased mortality risk and create a vicious cycle