Various Patterns of the Derangement of Liver Function Tests in End-Stage Renal Disease Patients on Maintenance Hemodialysis-A Single Centered Study from Pakistan
Main Article Content
Abstract
Background: Chronic kidney disease (CKD) patients on maintenance hemodialysis often present with various comorbidities, among which liver dysfunction is not uncommon. The prevalence of hepatitis B and C among this population suggests a multifaceted interaction between liver health and renal impairment. Studies have indicated that serum aminotransferase levels are inversely related to the severity of CKD and may be affected by hemodialysis.
Objective: This study aimed to delineate the patterns and etiologies of liver function test derangements in an end-stage renal disease (ESRD) cohort on maintenance hemodialysis, assessing the association between dialysis duration and liver enzyme levels.
Methods: In this cross-sectional observational study, 91 ESRD patients undergoing hemodialysis at a single center were evaluated. Liver function patterns were classified as hepatocellular, cholestatic, or mixed based on serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALKP), and gamma-glutamyl transferase (GGT). Statistical analysis was performed using SPSS version 25, with a significant p-value set at ≤ 0.05.
Results: The average age of patients was 44 ± 15 years. The majority had been on dialysis for one (41.8%) or two years (33%). Hepatitis C (20.9%) was the predominant cause of viral hepatitis, followed by Hepatitis B (13.2%). Sepsis was identified as a major contributor to liver enzyme derangement (58.2%). The most common pattern of deranged liver enzymes was mixed (49.5%), followed by cholestatic (27.5%) and hepatocellular (23%). Elevated transaminases were noted, with AST at 227.8 ± 264.1 IU/mL and ALT at 237.1 ± 281.8 IU/mL.
Conclusion: In the studied ESRD population, sepsis was the leading cause of liver dysfunction, with a higher incidence of mixed liver enzyme pattern derangements. The elevated aminotransferase levels contrast with previous studies, suggesting the need for enhanced infection control and consistent monitoring of liver health in the hemodialysis setting.
Article Details
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Rule AD, Amer H, Cornell LD, et al. The Association Between Age and Nephrosclerosis on Renal Biopsy Among Healthy Adults. Ann Intern Med. 2010;152:561–567.
Pratt DS, Kaplan MM. Evaluation of Abnormal Liver-Enzyme Results in Asymptomatic Patients. N Engl J Med. 2000; 342(17):1266–71.
Nesseler N, Launey Y, Aninat C, Morel F, Mallédant Y, Seguin P. Clinical Review: The Liver in Sepsis. Crit Care. 2012;16:235.
Ravel V, Streja E, Molnar MZ, et al. Association of Aspartate Aminotransferase With Mortality in Hemodialysis Patients. Nephrol Dial Transplant. 2016;31(5):814-822.
Ray L, Nanda SK, Chatterjee A, Sarangi R, Ganguly S. A Comparative Study of Serum Aminotransferases in Chronic Kidney Disease With and Without End-Stage Renal Disease: Need for New Reference Ranges. Int J Appl Basic Med Res. 2015 Jan-Apr;5(1):31-5.
Sette LHB, Lopes EPDA. Clinics (Sao Paulo). 2014 Apr;69(4):271-278.
Yasuda K, Okuda K, Endo N, et al. Hypoaminotransferasemia in Patients Undergoing Long-Term Hemodialysis: Clinical and Biochemical Appraisal. Gastroenterology. 1995;109(4):1295–300.
Souza JF, Longui CA, Miorin LA, Sens YA. Gamma-Glutamyltransferase Activity in Chronic Dialysis Patients and Renal Transplant Recipients With Hepatitis C Virus Infection. Transplant Proc. 2008;40(5):1319-23.
Idrees MK, Batool S, Ahmed E. Hepatitis B Virus Among Maintenance Hemodialysis Patients: A Report from Karachi, Pakistan. J Pak Med Assoc. 2011 Dec;61(12):1210-4.
Liberato IR, Lopes EP, Cavalcante MA, et al. Liver Enzymes in Patients With Chronic Kidney Disease Undergoing Peritoneal Dialysis and Hemodialysis. Clinics (Sao Paulo). 2012;67(2):131-134. doi:10.6061/clinics/2012(02)07.
Yaseen RT, Laeeq SM, Ismail H, et al. Etiologies Associated With Elevated Liver Enzymes After Renal Transplant. Exp Clin Transplant. 2024 Jan;22(Suppl 1):167-172. doi: 10.6002/ect.MESOT2023.P5. PMID: 38385391.
Lala V, Zubair M, Minter DA. Liver Function Tests. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482489/
Allawi AA, Mahmood MY, Hammied FA. Correlation Between Liver Enzymes and Chronic Kidney Disease Iraqi Patients With or Without Hemodialysis.
Sette LH, Lopes EP. The Reduction of Serum Aminotransferase Levels Is Proportional to the Decline in the Glomerular Filtration Rate of Patients with Chronic Kidney Disease. Clinics. 2015;70(5):346-349.
Sette LH, Lopes EP. Liver Enzymes Serum Levels in Patients with Chronic Kidney Disease on Hemodialysis: A Comprehensive Review. Clinics. 2014;69(4):271-278.
Fabrizi F, Lunghi G, Finazzi S, et al. Decreased Serum Aminotransferase Activity in Patients with Chronic Renal Failure: Impact on the Detection of Viral Hepatitis. Am J Kidney Dis. 2001;38(5):1009-15.
Ghenu MI, Dragoş D, Manea MM, et al. Pathophysiology of Sepsis-Induced Cholestasis: A Review. JGH Open. 2022 May 25;6(6):378-387. doi: 10.1002/jgh3.12771. PMID: 35774351; PMCID: PMC9218521.
Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of Hepatitis C Prevalence and Seroconversion in Hemodialysis Units from Three Continents: The DOPPS. Kidney Int. 2004;65:2335-2342.
Di Napoli A, Pezzotti P, Di Lallo D, et al. Epidemiology of Hepatitis C Virus Among Long-Term Dialysis Patients: A 9-Year Study in an Italian Region. Am J Kidney Dis. 2006;48:629-637.
Sun J, Yu R, Zhu B, et al. Hepatitis C Infection and Related Factors in Hemodialysis Patients in China: Systematic Review and Meta-Analysis. Ren Fail. 2009;31:610-620.
Alavian SM, Kabir A, Ahmadi AB, et al. Hepatitis C Infection in Hemodialysis Patients in Iran: A Systematic Review. Hemodial Int. 2010;14:253-262.
Goodkin DA, Bragg-Gresham JL, Koenig KG, et al. Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14:3270-3277.
Ozer Etik D, Ocal S, Boyacioglu AS. Hepatitis C Infection in Hemodialysis Patients: A Review. World J Hepatol. 2015;7(6):885-895. [PMID: 25937865 DOI: 10.4254/wjh.v7.i6.885]