Kidney Int. 2008;74:655-663

Elevated serum normalized alkaline phosphatase (nAP) is associated with significantly higher risks of hospitalization and death among hemodialysis patients, independent of calcium, phosphorus, and parathyroid hormone levels, ac-cording to a study of patients in 12 countries.

Compared with subjects who had normal nAP (1 or less), those with mildly elevated nAP (1.4 or less, but greater than 1) were at 42%, 56%, 66%, and 22% in-creased risk of hospitalization due to fracture, hyperparathyroidism, liver disease, and major adverse cardiovascular events, respectively.

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For markedly elevated nAP (greater than 1.4), the figures were 67%, 145%, 72%, and 25%. Compared with normal nAP, markedly elevated nAP was associated with a 24% increased risk of vascular access infection, and mildly elevated nAP was associated with a 76% increased risk of hospitalization for gall bladder-related ailments.

In addition, the risk for death from all causes was 25% and 38% greater for patients with mildly and markedly elevated baseline nAP, respectively, vs. those with normal nAP. Compared with patients who had normal nAP, those with mildly or markedly elevated nAP had a 33% and 30% increased risk of cardiovascular death. Infection-related mortality risk was 51% greater for patients with markedly elevated nAP vs. patients who had normal nAP.