Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis
Alkaline phosphatase (Alk-Phos) is a powerful predictor of death in patients with end-stage kidney disease (ESKD) and oxidative stress is a strong inducer of Alk-Phos in various tissues. We tested the hypothesis that oxidative stress, as estimated by a robust marker of systemic oxidative stress like...
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doaj-d32312b4b5514770b3c24d407f132ce92020-11-24T20:59:20ZengHindawi LimitedOxidative Medicine and Cellular Longevity1942-09001942-09942016-01-01201610.1155/2016/84906438490643Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on DialysisClaudia Torino0Francesco Mattace-Raso1Jan L. C. M. van Saase2Maurizio Postorino3Giovanni Luigi Tripepi4Francesca Mallamaci5Carmine Zoccali6PROGREDIRE Study Group7CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, 89124 Reggio Calabria, ItalyDepartment of Internal Medicine, Erasmus University Medical Centre, 3015 CE Rotterdam, NetherlandsDepartment of Internal Medicine, Erasmus University Medical Centre, 3015 CE Rotterdam, NetherlandsCNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, 89124 Reggio Calabria, ItalyCNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, 89124 Reggio Calabria, ItalyCNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, 89124 Reggio Calabria, ItalyCNR-IFC and Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, c/o EUROLINE S.r.l., Via Vallone Petrara 57-59, 89124 Reggio Calabria, ItalyCNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, 89124 Reggio Calabria, ItalyAlkaline phosphatase (Alk-Phos) is a powerful predictor of death in patients with end-stage kidney disease (ESKD) and oxidative stress is a strong inducer of Alk-Phos in various tissues. We tested the hypothesis that oxidative stress, as estimated by a robust marker of systemic oxidative stress like γ-Glutamyl-Transpeptidase (GGT) levels, may interact with Alk-Phos in the high risk of death in a cohort of 993 ESKD patients maintained on chronic dialysis. In fully adjusted analyses the HR for mortality associated with Alk-Phos (50 IU/L increase) was progressively higher across GGT quintiles, being minimal in patients in the first quintile (HR: 0.89, 95% CI: 0.77–1.03) and highest in the GGT fifth quintile (HR: 1.13, 95% CI: 1.03–1.2) (P for the effect modification = 0.02). These findings were fully confirmed in sensitivity analyses excluding patients with preexisting liver disease, excessive alcohol intake, or altered liver disease biomarkers. GGT amplifies the risk of death associated with high Alk-Phos levels in ESKD patients. This observation is compatible with the hypothesis that oxidative stress is a strong modifier of the adverse biological effects of high Alk-Phos in this population.http://dx.doi.org/10.1155/2016/8490643 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Claudia Torino Francesco Mattace-Raso Jan L. C. M. van Saase Maurizio Postorino Giovanni Luigi Tripepi Francesca Mallamaci Carmine Zoccali PROGREDIRE Study Group |
spellingShingle |
Claudia Torino Francesco Mattace-Raso Jan L. C. M. van Saase Maurizio Postorino Giovanni Luigi Tripepi Francesca Mallamaci Carmine Zoccali PROGREDIRE Study Group Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis Oxidative Medicine and Cellular Longevity |
author_facet |
Claudia Torino Francesco Mattace-Raso Jan L. C. M. van Saase Maurizio Postorino Giovanni Luigi Tripepi Francesca Mallamaci Carmine Zoccali PROGREDIRE Study Group |
author_sort |
Claudia Torino |
title |
Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis |
title_short |
Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis |
title_full |
Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis |
title_fullStr |
Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis |
title_full_unstemmed |
Oxidative Stress as Estimated by Gamma-Glutamyl Transferase Levels Amplifies the Alkaline Phosphatase-Dependent Risk for Mortality in ESKD Patients on Dialysis |
title_sort |
oxidative stress as estimated by gamma-glutamyl transferase levels amplifies the alkaline phosphatase-dependent risk for mortality in eskd patients on dialysis |
publisher |
Hindawi Limited |
series |
Oxidative Medicine and Cellular Longevity |
issn |
1942-0900 1942-0994 |
publishDate |
2016-01-01 |
description |
Alkaline phosphatase (Alk-Phos) is a powerful predictor of death in patients with end-stage kidney disease (ESKD) and oxidative stress is a strong inducer of Alk-Phos in various tissues. We tested the hypothesis that oxidative stress, as estimated by a robust marker of systemic oxidative stress like γ-Glutamyl-Transpeptidase (GGT) levels, may interact with Alk-Phos in the high risk of death in a cohort of 993 ESKD patients maintained on chronic dialysis. In fully adjusted analyses the HR for mortality associated with Alk-Phos (50 IU/L increase) was progressively higher across GGT quintiles, being minimal in patients in the first quintile (HR: 0.89, 95% CI: 0.77–1.03) and highest in the GGT fifth quintile (HR: 1.13, 95% CI: 1.03–1.2) (P for the effect modification = 0.02). These findings were fully confirmed in sensitivity analyses excluding patients with preexisting liver disease, excessive alcohol intake, or altered liver disease biomarkers. GGT amplifies the risk of death associated with high Alk-Phos levels in ESKD patients. This observation is compatible with the hypothesis that oxidative stress is a strong modifier of the adverse biological effects of high Alk-Phos in this population. |
url |
http://dx.doi.org/10.1155/2016/8490643 |
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