Alkaline Phosphatase and Cumulative Vascular Access Burden in Maintenance Hemodialysis: An Exploratory Clinical Study

Background: Vascular access dysfunction remains a major challenge in maintenance hemodialysis (HD). Although chronic kidney disease–mineral and bone disorder may contribute to vascular pathology, the relationship between mineral metabolism markers and cumulative vascular access deterioration remains poorly defined. Methods: This retrospective single-center study included 74 patients receiving maintenance HD. Cumulative vascular access burden was defined by reinterventions, definitive access losses, and additional vascular accesses. Associations with parathyroid hormone (PTH), calcium, phosphorus, calcium–phosphorus product, and alkaline phosphatase (ALP) were evaluated using group comparisons, correlation analysis, and logistic regression. Results: Patients with cumulative vascular access burden had higher ALP levels than those without burden (92.0 vs. 78.0 U/L, p = 0.010), whereas PTH, calcium, phosphorus, and calcium–phosphorus product did not differ significantly. ALP correlated with cumulative burden (Spearman’s ρ = 0.303, p = 0.009), and this association remained statistically significant after adjustment for age, BMI, PTH, and phosphorus (OR per 10 U/L increase = 1.226, 95% CI 1.059–1.418; p = 0.006). Conclusions: Higher ALP levels were associated with greater cumulative historical vascular access burden after adjustment for selected clinical and biochemical variables. These exploratory findings do not establish the prognostic value of ALP for future vascular access outcomes and require prospective validation.