Evaluation and Comparison of Hepatic Enzymes in Different CKD Categories

Abstract

Background: Chronic Kidney Disease is a global public health issue, with increasing incidence. It consists wide spectrum of renal conditions that lead to progressive decline in renal function and abnormal GFR. Liver disorders are common among chronic kidney diseases. LFT's particularly play a vital role in the diagnosis and monitoring CKD patients. Currently, eGFR considered being the most valuable parameter for diagnosing CKD. But it has some limitations, it is not done routinely in apparently healthy people, secondly, GFR has different normal values for different ethnic groups so the formulae for calculating eGFR being used in west might not be applicable in eastern population and vice versa. Objectives: This study was carried out to compare hepatic enzymes of patients with different stages of chronic kidney disease. Materials and methods: A total of 257 persons were recruited. Cases were divided into two subgroups based on the glomerular filtration rate (GFR). Subgroup 1: 85 Cases had GFR <15, subgroup 2: 99 cases with GFR > 15 and Subgroup 3: 73 normal healthy controls. The hepato-renal profile was done for all cases and controls. Results: Hepatic transferases in the patients undergoing dialysis fell into the normal range. But the same enzymes showed a marked elevation in the patients with chronic kidney disease having non-invasive treatment. Alkaline phosphatase showed mark elevation for both groups A and B as compared to normal controls.

Evaluation of liver function biomarkers, blood pressure, and anthropometric parameters among chronic kidney disease patients: Laboratory-based cross-sectional study in Northwest Ethiopia

“…This corroborated with the previous studies, revealing that hypertension is highly prevalent in CKD patients [ 20 , 21 ].This indicates that hypertension has a higher chance of occurrence as the severity of CKD is increased although it still warrants the need of further large-scale confirmatory study. Moreover, unlike the current results, which reported that BP is negatively correlated with liver aminotransferases, studies conducted by Alhawish et al and Sette and Lope showed positive correlation between the two parameters [ [13] , [14] ]. [[, 14 ] This variation could be due to the difference in the study population as BP varies across a population due to different factors.…”

“…Moreover, unlike the current results, which reported that BP is negatively correlated with liver aminotransferases, studies conducted by Alhawish et al and Sette and Lope showed positive correlation between the two parameters [ [13] , [14] ]. [[, 14 ] This variation could be due to the difference in the study population as BP varies across a population due to different factors.…”

“…Our findings are consistent with previous studies conducted by Alhawish et al and Sette and Lope. 13,14 Our study also demonstrated that the mean serum AST and ALT levels were significantly lowered when the severity and clinical stages of CKD is increased, which isin line with several prior reports [ 12 , 14 , 15 , 26 , 27 ]. The strong positive correlations between the serum levels of AST and ALT with eGFR in the current study indicate that as the severity of CKD increases, the mean values of aminotransferases significantly decreased.…”

“…Other previous studies also reported that AST and ALT are significantly reduced in CKD patients compared to healthy controls [ [12] , [13] , [14] ]. It has also been shown that total and direct bilirubin levels were lowered and raised, respectively, in CKD patients [ 15 ].Anotherpriorpublication also revealed that the levels of aminotransferases are in the normal range in CKD patients with ESRD having comorbid viral hepatitis [ 11 ].These show the in consistent findings of the levels of liver function biomarkers in CKD patients with- and without ESRD in different study areas [ [12] , [13] , [14] , 16 ]. Consequently, the diagnosis of comorbid hepatic diseases in CKD patients challenges clinicians as a reduction in liver aminotransferases underestimates the burden of the disease.…”

“…Hepatic disease and hypertension are common comorbid conditions in CKD patients; so CKD patients need regular monitoring of liver function biomarkers, BP, and anthropometric parameters to detect concomitant diseases [ 10 , 17 , 18 ]. Serum levels of AST, ALT, total bilirubin, and direct bilirubin are important biomarkers for the diagnosis and monitoring of hepatocellular inflammation and damage [ 11 ].However, serum aminotransferases would decrease in CKD patients as compared with apparently healthy individuals and not usually raised beyond their normal upper limit even in the presence of liver comorbidities [ [12] , [13] , [14] ] This challenges physicians to diagnose hepatic disease among CKD patients since the presence of normal AST and ALT values never confirm the absence of hepatic disease. The challenge alarms the urgent need for new reference ranges for serum aminotransferases in CKD patients to rule out hepatic dysfunction during diagnosis.…”