Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com Editor Marie Benz: What are the main findings of the study?

In this cohort study of more than 11,000 kidney transplant patients, pre-transplant serum alkaline phosphatase >120 U/L was associated with increased risk of mortality (both all-cause and cardiovascular mortality), whereas there was no association between serum PTH or serum calcium levels and post-transplant outcomes.

Hemodialysis.com: Were any of the findings unexpected?

The observed trend of an association of a high pre-transplant serum alkaline phosphatase >120 U/l with mortality, along with cubic spline curves showing a dose-dependent increasing risk of all cause and cardiovascular death with increase of alkaline phosphatase, is novel and clinically relevant.  

We believe that this particular group of recipients with high serum alkaline phosphatase levels should be further analyzed.  

In addition, it was surprising that higher time-averaged serum iPTH level did not show any association with risk of graft failure or death in our cohort. Similar results were found in cardiovascular and infectious mortality

Hemodialysis.com: What should clinicians and patients take away from your report? 

Serum alkaline phosphatase >120 U/l in dialysis patients can be a marker of underlying disease, which is associated worse outcome even after a kidney transplantation.

Hemodialysis.com: What recommendations do you have for future research as a result of this study?  

Additional studies are needed to confirm this association using bone-specific alkaline phosphatase. Moreover, further clinical trials are needed to better define optimal target levels of MBD markers in transplant-waitlisted dialysis patients.

Reference:

Association of Pre-Kidney Transplant Markers of Mineral and Bone Disorder with Post-Transplant Outcomes
Miklos Z. Molnar, Csaba P. Kovesdy, Istvan Mucsi, Isidro B. Salusky, and Kamyar Kalantar-Zadeh
Outcomes CJASN CJN.01910212; published ahead of print September 6, 2012, doi:10.2215/CJN.01910212