Serum Alkaline Phosphatase Levels and Increased Risk of Brain Hemorrhage in Hemodialysis Patients: The Q-Cohort Study
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- Kitamura Hiromasa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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- Yamada Shunsuke
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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- Hiyamuta Hiroto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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- Yotsueda Ryusuke
- Munakata Medical Association Hospital
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- Taniguchi Masatomo
- Fukuoka Renal Clinic
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- Tokumoto Masanori
- Department of Internal Medicine, Fukuoka Dental College
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- Tsuruya Kazuhiko
- Department of Nephrology, Nara Medical University
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- Nakano Toshiaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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- Kitazono Takanari
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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説明
<p> Aim: Elevated serum alkaline phosphatase (ALP) levels have been associated with increased risks of all-cause and cardiovascular mortality in patients receiving hemodialysis. However, little is known about the impact of serum ALP levels on the development of stroke, such as brain hemorrhage and infarction.</p><p>Methods: A total of 3,497 patients receiving maintenance hemodialysis registered in the multicenter observational Q-Cohort Study were analyzed. The primary outcomes were the incidences of brain hemorrhage and infarction. The covariate of interest was serum ALP levels. Patients were divided into tertiles based on their serum ALP levels (U/L) at baseline (T1, ＜69.3; T2, 69.3–98.4; T3, ＞98.4). The risks of brain hemorrhage, brain infarction, and composite stroke were estimated using Cox proportional hazards models and competing risk models with all-cause death as a competing risk.</p><p>Results: A total of 89 patients developed brain hemorrhage and 195 patients developed brain infarction during the 4-year follow-up period. The risk of brain hemorrhage in the highest tertile (T3) was significantly higher than that in the lowest tertile (T1) (multivariable-adjusted hazard ratio [95% confidence interval], 1.93 [1.12–3.35], subdistribution hazard ratio, 1.91 [1.10–3.30]). However, there was no significant association between serum ALP levels and the risk of brain infarction or composite stroke.</p><p> Conclusions: Higher serum ALP levels are associated with an increased risk of brain hemorrhage, but not brain infarction, in patients receiving maintenance hemodialysis. High serum ALP level is thus an important risk factor for brain hemorrhage in hemodialysis patients.</p>
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- Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ
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Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ 29 (6), 923-936, 2022-06-01
一般社団法人 日本動脈硬化学会