by Lei Hua, Yongshou Tao, Liangru Shen Background Cardiovascular-Kidney-Metabolic (CKM) syndrome involves disordered mineralization processes. Herein, we investigated the serum alkaline phosphatase (ALP), calcium, and phosphorus across CKM stages.
Methods This study analyzed 15,233 eligible participants in National Health and Nutrition Examination Survey (2009–2018) using survey-weighted multinomial logistic regression to assess associations of ALP, calcium, and phosphorus. Restricted cubic splines assessed non-linear relationships, while Cox models examined mortality risks.
Two-sample Mendelian randomization (MR) explored causal relationships. Results Relative risk ratios (RRRs) and 95% confidence intervals (95% CI) were calculated with multinomial logistic regression.
Compared with stage 0, ALP was positively associated with the likelihood of being classified into stage 2 (RRR, 1.23[95% CI, 1.11–1.37]), stage 3 (RRR, 1.99 [95% CI, 1.48–2.67]), stage 4a (RRR, 1.29 [95% CI, 1.14–1.46]), stage 4b (RRR, 1.35 [95% CI, 1.16–1.58]).
PLOS ONE (Medicine) published a clinical update in Research Highlights on 18 Jun 2026.
The item focuses on Stage-specific associations of mineralization markers with CKM syndrome: Nationwide survey and genetic evidence for Alkaline phosphatase’s unique clinical role.
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