The value of serum transaminases (ST) in evaluating hepatitis B (HBV) and C (HCV) infection was studied in 217 hemodialysis (HD) patients and 804 normal controls. Mean serum aspartate aminotransferase (AST) was 22.3 (22.0-22.7) and 22.6 (21.6-23.6) IU/1 or 0.371 (0.366-0.378) and 0.376 (0.36-0.393) µkat/1 in controls and HD patients, respectively (nonsignificant), while mean serum alanine aminotransferase (ALT) was 20.3 (19.9-20.7) and 16.3 (15.3-17.3) IU/1 or 0.338 (0.331-0.345) and 0.271 (0.255-0.288) µkat/1 in these two groups (p < 0.001). However, both AST and ALT became significantly depressed in HD patients after adjusting for age, gender, HBV surface antigen (HBsAg) and anti-HCV. The usual practice of regarding AST and ALT as being ‘abnormal’ in evaluating viral hepatitis when they exceeded the upper reference range (40 and 46 IU/1 or 0.666 and 0.766 µkat/1 in our laboratory) was then critically assessed by the receiver operating characteristic (ROC) curve. ROC analysis showed that ST was useless in detecting HBsAg, while the best cutoff point for detecting the presence of anti-HCV was 18 IU/1 (0.3 µkat/1) for AST and 16 IU/1 (0.266 µkat/1) for ALT in HD patients, respectively. These are considerably lower than the conventional criteria for an ‘abnormal’ ST. We conclude that ST are decreased in HD patients and that the cutoff value of ST for detecting HCV should be set at lower levels to enhance their diagnostic yield.

Background/Aims: Hemodialysis (HD) patients are prone to developing peptic ulcers. However, of all the risk factors associated with peptic ulcers, none have been shown to be more prevalent in HD patients than in the general population. However, salivary epidermal growth factor (EGF) may play a role in peptic ulcer diseases. Methods: Salivary EGF levels and bioactivities were assayed in 47 maintenance HD patients and 30 normal controls, and the molecular weights of EGF were assessed using high-performance liquid chromatography (HPLC). Results: Salivary EGF levels were not different between both groups of subjects (4.2 ± 0.34 vs. 5 ± 0.54 ng/mg protein, NS), and HPLC revealed that salivary EGF in both groups had similar molecular weights. However, salivary EGF bioactivity was significantly depressed in the HD patients as compared to the normal controls (0.59 ± 0.08 vs. 1.55 ± 0.15 ng/mg protein, p < 0.01). Stepwise multiple regression showed that the low salivary EGF levels were associated with female gender (p < 0.05), while low salivary EGF bioactivity was associated with HD per se (p < 0.05). In the 22 HD patients who underwent gastric endoscopy, salivary EGF bioactivity was significantly lower in those with peptic ulcers than in those without (0.38 ± 0.08 vs. 0.69 ± 0.08 ng/mg protein, p < 0.05). Conclusion: Decreased salivary EGF bioactivity may contribute to peptic ulcer disease among maintenance HD patients.