Identificação de ponto de corte no nível sérico da alanina aminotransferase para rastreamento da hepatite C em pacientes com insuficiência renal crônica em hemodiálise

Abstract

The patients with chronic renal failure in hemodialysis present low levels of serum alanine aminotransferases. In order to establish a better cutoff value for ALT in hepatitis C screening of hemodialysis patients, the ALT levels were measured monthly in 235 patients, being excluded those that presented average above the upper limit of normality. The cutoff value was identified by construction of a ROC curve (receiver operating characteristic). Among 202 patients, 15 (7.4%) presented antibodies to hepatitis C virus (anti-HCV) and 187 (92.6%) were anti-HCV negative, with an ALT average of 0.7 and of 0.5 from ULN (p <0.0001), respectively. The better cutoff value for ALT was at 0.6 from ULN, with sensitivity of 67% and specificity of 75% in anti-HCV screening. These results suggest that ULN of ALT could be reduced for 60% from conventional limit, when we are evaluating patients with CRF in hemodialysis.

Detection of hepatitis C virus in patients with terminal renal disease undergoing dialysis in southern Brazil: prevalence, risk factors, genotypes, and viral load dynamics in hemodialysis patients

“…Altered ALT levels are not common in patients with HCV undergoing hemodialysis treatments, which suggests that aminotransferases are not good predictors of hepatocellular injury for these patients because it is believed that there is enzymatic inhibition of the aminotransferases due to uremic toxins, pyridoxine deficiency (cofactor of aminotransferases), loss of enzymes in dialysis, interference of other dialyzable substances in the dosage of transaminase activity and lactate consumption of the factors that are necessary for the dosage of transaminase activity [39]. Several studies have shown that the ALT levels can be higher in HCV-positive patients compared with HCV-negative individuals, even when the values are below those considered to be normal, and the aminotransferase variations are related to the HCV viral load [34,42]. …”

Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review

“…After evaluating 202 CKD patients on HD, 15 (7.4%) of whom were anti-HCV-positive, our group determined that the cut-off value for ALT stood at 60% of ULN, with a sensitivity of 67% and specificity of 75% in identifying anti-HCV-positive patients (54). We observed a similar reduction when evaluating 217 patients on HD, 18 (8.3%) of whom were anti-HCV-positive, and 17 (7.8%) of whom were also HCV-RNA-positive.…”

Infecção pelo vírus da hepatite c em pacientes em hemodiálise: prevalência e fatores de risco

“…Sabe-se que, por razões ainda não totalmente elucidadas, os pacientes com DRC em HD cursam com valores de ALT menores que os pacientes com função renal normal (25,26,27) . Por este motivo, neste cenário clínico, vários estudos têm sugerido a necessidade de reduzir o LSN da ALT, objetivando aumentar a sensibilidade dessa enzima como preditor de viremia em pacientes HCV-RNA positivos (24,31,42) . Também é importante salientar que, devido à viremia intermitente observada no paciente em HD e ao padrão flutuante da ALT, medida isolada desta enzima não deve ser utilizada como ferramenta preditora de viremia (10,20,21,24,36,38) .…”

“…A probabilidade de infecção aumenta consideravelmente após 10 anos de HD (31,43,45,46,49,60) . Carneiro et al (12) , em estudo realizado em unidades de diálise da cidade de Goiânia, GO, demonstraram que pacientes em HD por mais de 3 anos apresentaram risco de aquisição do VHC 13,6 vezes maior quando comparados aos pacientes com menos de 1 ano de tratamento.…”