Impact of Decreased Serum Transaminase Levels on the Evaluation of Viral Hepatitis in Hemodialysis Patients

Abstract

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.

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

“…In this study, only 1.5% received antiviral therapy, whereas hundreds of thousands of patients with HCV in the general population have been prescribed the new agents. It is possible that nephrologists do not recognize that HCV induces severe liver damage in patients on HD because, unlike in the general population, serum aminotransferase concentrations often remain within the normal ranges or are only slightly elevated in this setting (37)(38)(39). In this study, the mean values for ALT and AST were only 22.6 and 21.8 U/L, respectively; only one HCV+ patient had ALT elevation .140 U/L and only one HCV+ patient had AST elevation .100 U/L.…”

Evaluation of serum aminotransaminases and bilirubin in different treatment regimens for chronic hepatitis C virus

“…One of the newly approved DAAs indicated for the treatment of genotype 4 HCV is sofosbuvir, an oral HCV-specific NS5B nucleotide polymerase inhibitor with demonstrated clinical efficacy in patients with genotype 1 to 6 HCV [12,13]. Aminotransferase enzymes are sensitive indicators of liver cell injury and helpful in recognizing acute hepatocellular diseases [14]. In this study we aimed to assess the effect of antiviral therapy on the liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin concentrations before and after treatment using standard methodologies.…”

Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients

“…If assessed by these criteria, the enzyme levels are high in most patients. 20, 21 The levels we found were also higher than the lower reference values -ALT > 16 IU/l and AST > 18 IU/l in 7 (70%) viremic patients.…”