{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T17:26:25Z","timestamp":1794072385709,"version":"4.8.0"},"reference-count":50,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T00:00:00Z","timestamp":1665100800000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,9,2]]},"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Elevated baseline serum alkaline phosphatase (ALP) may correlate with higher medium-term to long-term mortality in the general population and in patients with chronic kidney disease. However, few data are available on the association between serum ALP and the short-term prognosis of patients on haemodialysis (HD). We verified the association of ALP levels and bacteraemia or death in maintenance HD patients suspected of bacteraemia in an outpatient setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We analysed 315 consecutive HD patients suspected of having bacteraemia with two sets of blood culture drawn on admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Admission to two tertiary-care university medical centres from January 2013 to December 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Consecutive cases on maintenance HD aged\u226518 years. Cases of hospitalised patients who had been transferred from another hospital, had a dialysis vintage&lt;2 months, were also undergoing peritoneal dialysis, and\/or were receiving HD less than once a week were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome measure was bacteraemia and secondary outcome was in-hospital death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 315 cases included in the study, 187 had baseline-measured ALP levels, with a cut-off value on ROC analysis of 360\u2009U\/L (Area Under the Curve (AUC) 0.60, sensitivity 0.49, specificity 0.76). In multivariate analysis, there was a statistically significant association between a higher ALP in hospital visit and bacteraemia (OR: 2.37, 95%\u2009CI: 1.17 to 4.83). However, there were no statistically significant associations between higher ALP and in-hospital death (OR: 1.20, 95%\u2009CI: 0.57 to 2.54). A sensitivity analysis of 187 patients with no missing ALP values also demonstrated a significant association between elevated ALP and bacteraemia, but no significant association between ALP and in-hospital death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated ALP is a predictor of bacteraemia. In HD patients suspected of bacteraemia in outpatient settings, increased ALP levels were associated with increased likelihood of confirmed disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058666","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T12:10:57Z","timestamp":1665144657000},"page":"e058666","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Association between serum alkaline phosphatase and bacteraemia in haemodialysis outpatients: a multicentre retrospective cross-sectional study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0315-1395","authenticated-orcid":false,"given":"Aya","family":"Katasako","sequence":"first","affiliation":[{"name":"Department of Nephrology, Iizuka Hospital, Iizuka, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Iizuka Hospital, Iizuka, Fukuoka, Japan"},{"name":"Clinical Research Support Office, Iizuka Hospital, Iizuka, Fukuoka, Japan"},{"name":"Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan"},{"name":"Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiko","family":"Raita","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Okinawa Chubu Hospital, Uruma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shungo","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Transformative Infection Control Development Studies, Osaka University Graduate School of Medicine, Osaka, Japan"},{"name":"Division of Fostering Required Medical Human Resources, Center for Infectious Disease Education and Research(CiDER), Osaka University, Osaka, Japan"},{"name":"Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Tochitani","sequence":"additional","affiliation":[{"name":"Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0435-7106","authenticated-orcid":false,"given":"Minoru","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Saku Central Hospital, Saku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Nishioka","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiichiro","family":"Fujisaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Iizuka Hospital, Iizuka, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,10,7]]},"reference":[{"key":"2025120520542882000_12.10.e058666.1","doi-asserted-by":"publisher","DOI":"10.1159\/000360027"},{"key":"2025120520542882000_12.10.e058666.2","unstructured":"The Japanese Society for dialysis therapy. 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