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

Abstract

We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis.Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words “transaminases” “aspartate aminotransferase” “alanine aminotransferase” “gamma glutamyl transferase,” “liver enzymes”, AND “dialysis” OR “hemodialysis”.A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease.The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis) than in the patients with normal renal function; this reduction has a multifactorial origin.

<p>Common and Unique Factors and the Bidirectional Relationship Between Chronic Kidney Disease and Nonalcoholic Fatty Liver in Type 2 Diabetes Patients</p>

“…This finding is consistent with a previous study that reported lower SGPT levels in patients with CKD on hemodialysis (with or without viral hepatitis) than in patients with normal renal function. 37 This may explain the lack of an association between SGPT and CKD in the present study.…”

Alterations of Hematological Parameters, Hemoglobin and Hematocrit With Liver Enzymes, Aspartate Transaminase and Alanine Transaminase Among Patients With Chronic Kidney Disease Undergoing Hemodialysis in Aljouf Region, Saudi Arabia

“…There was in one study an increase in the sensitivity of ALT from 55% to 76% for the diagnosis of discrete liver diseases and specificity was reduced from 97% to 89% when the ULN was reduced [11,12]. A second study found the risk of mortality from liver disease was higher in individuals with normal levels of ALT that were close to the ULN compared with individuals with lower ALT levels in a large Korean population.…”

“…There has been a proposal to reduce the upper limit of the normal (ULN) of ALT to approximately 70% of the conventional limits while screening for liver abnormalities in patients without CKD [11]. There was in one study an increase in the sensitivity of ALT from 55% to 76% for the diagnosis of discrete liver diseases and specificity was reduced from 97% to 89% when the ULN was reduced [11,12].…”

Current Management of Chronic Hepatitis B and C in Chronic Kidney Disease

“…However, patients with ESRD often have lower baseline aminotransferases for unclear reasons (possibly caused by hemodilution, pyridoxine deficiency, or homocysteine elevation). 11 In these patients, aminotransferase levels that are within the normal range may mask increased inflammatory activity. When aminotransferases are noted to increase from baseline, even if still within the normal range, liver biopsy may be needed to more accurately demonstrate the burden of inflammation.…”