AUTHOR=Xia Wenkai , Hua Xi , Sun Dong , Xie Xiangcheng , Hu Hong 

TITLE=Albumin-to-alkaline phosphatase ratio as a novel prognostic indicator in patients undergoing peritoneal dialysis: a propensity score matching analysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1302603

DOI=10.3389/fmed.2024.1302603

ISSN=2296-858X

ABSTRACT=Background: Though the albumin-to-alkaline phosphatase ratio (AAPR) is used as a biomarker in various diseases, little is known about its effect on outcomes after peritoneal dialysis (PD).Methods: This multicenter retrospective study comprised 357 incident PD patients stratified according to the AAPR. Propensity score matching (PSM) was performed to identify 85 patients for a well-matched comparison of all-cause and cardiovascular mortality. Propensity score matching (PSM) was performed to identify 85 patients for a well-matched comparison of all-cause and cardiovascular mortality. Using Cox regression, we performed univariate and multivariate analyses to investigate the prognostic value of the AAPR and established a Kaplan-Meier curve-predicted nomogram to estimate expected overall survival (OS). We assessed the predictive accuracy using the concordance index (c-index).We found that the optimal cut-off of the AAPR to predict mortality was 0.36. In the present cohort of patients undergoing PD, a low AAPR strongly correlated with worse OS. In the multivariate analysis, the AAPR was shown to be an independent marker predicting reduced OS , both before (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.08-2.60, P=0.020) and after PSM (HR 1.96, 95% CI 1.06-3.62, P=0.020). We also observed significant differences in OS in several subgroups, but not the group of patients with comorbidities. The c-index for prediction accuracy was 0.71 after PSM.both before (hazard ratio [HR] 1.68, 95% confidence interval [CI]   1.08-2.60, P=0.020) and after PSM (HR 1.96, 95% CI 1.06-3.62, P=0.020). We also observed significant differences in OS in several subgroups, but not the group of patients with comorbidities.A nomogram was established to predict overall survival, with a c-index for prediction accuracy was 0.71 after PSM.AAPR has potential as an independent prognostic biomarker in patients undergoing PD.