Aluminum-Containing Phosphate Binders, Serum Total Alkaline Phosphatase, and Mortality Among Hemodialysis Patients

Chih-Yang Chen ； Pei-Chen Wu ； Cheng-Jui Lin ； Chih-Jen Wu ； Chi-Feng Pan

《Acta Nephrologica》 33卷2期 (2019/06) Pp. 63-72

https://doi.org/10.6221/AN.201906_33(2).0002

摘要

BACKGROUND: Serum total alkaline phosphatase (Alk-P), a bone formation marker, is associated with mortality in hemodialysis (HD) patients. In the era of ultrapure dialysis water, aluminum intoxication is barely reported. However, aluminum-containing phosphate binders remain commonly been prescribed. Whether the use of oral aluminum phosphate been associated with lower Alk-P and altering the association between serum Alk-P and mortality were less studied. METHODS: This observational study was conducted at MacKay Memorial Hospital from July 1, 2014 to November 30, 2018. We included clinically stable patients on trice weekly HD for more than 3 months. We averaged their lab data and drug dose in consecutive 6 months between July 1, 2014 and June 30, 2015. We grouped our patients based on averaged serum Alk-P levels (＜ 120 IU/L vs. ≥ 120 IU/L). The main outcomes were all-cause and cardiovascular mortality. Using Cox proportional hazards regression model, we tested the association among oral aluminum dose, serum Alk-p, and mortality. Infection-related death was considered to be a competing risk when analyzing cardiovascular mortality. RESULTS: Among total 232 HD patients, the mean age was 63.6 ± 13.0 years, 44.8% were male, HD vintage was 7.6 ± 6.1 years, and diabetes mellitus (40.9%) and chronic glomerulonephritis (40.9%) accounted for the major causes of end-stage of renal disease. About 94% took aluminum hydroxide at a dose of 3.6 ± 2.2 pills per day. We found that more aluminum drug use was not associated with lower Alk-P and lower intact parathyroid hormone, and that patients with Alk-P ≥ 120 IU/L had higher mortality. Serum Alk-P was associated with all-cause and cardiovascular mortality, independent of the dose of aluminum-containing phosphate binders. CONCLUSION: Oral aluminum-containing phosphate binders were not associated with lower Alk-P, and did not alter the association between serum Alk-P and mortality.

關鍵字

aluminum-containing phosphate binder ； aluminum oxide ； hemodialysis ； mortality ； serum total alkaline phosphatase