Research Article | OPEN ACCESS
The Effects of Chronic Kidney Disease on Liver Function Tests: The Laboratory Interpretation Perspective
1Wilfred Kimani Gatua, 2Joseph J.N. Ngeranwa and 3Patrick Mbugua
1Department of Laboratory Medicine, Kenyatta National Hospital,
2Department of Biochemistry and Biotechnology, Kenyatta University,
3Department of Medicine, Renal Unit, Kenyatta National Hospital, Kenya
Asian Journal of Medical Sciences 2019 2:13-18
Received: December 13, 2018 | Accepted: March 6, 2019 | Published: July 25, 2019
Abstract
The aim of the study was to determine the levels of routinely measured liver function tests such as liver enzymes (AST, ALT, ALP, GGT & LDH), serum proteins (albumin and total) and serum bilirubins in patients with Chronic Kidney Disease (CKD). Clinical management of CKD involves frequent laboratory monitoring of liver function tests. It is therefore important to understand the levels of these biochemistry parameters in both healthy individuals and those with CKD for easier and accurate interpretation. A cross-sectional study of two groups of study subjects including patients with CKD and control group was used. A total of 180 subjects with CKD were recruited for the study plus another 200 healthy subjects who served as the control group and were recruited from among blood donors. About 2.0 mL of venous blood specimen was removed from each patient and from control subjects. Levels of the enzymes Aspartate Transaminase (AST), Alkaline Phosphatase (ALP), Alanine Transaminase (ALT), Gamma Glutamyl Transferase (γ-GT) and Lactate Dehydrogenase (LDH) were measured. Levels of serum protein and bilirubin were also determined in the two groups of study subjects. The Kolmogrov-Smirnov test was used to test the data for normality. The data obtained was parametric in nature and was tabulated as a mean and standard deviation. Parametric method of data analysis was used. Descriptive statistics used included parameters of location and parameters of dispersion. Means differences between investigated groups (control and chronic kidney disease patients) were assessed by ANOVA and post Anova statistical analysis. There were statistically significant differences (p<0.05) in the levels of serum protein and liver enzymes between patients with CKD and control group but no significant differences in the levels of serum bilirubin (p>0.05). The results suggest that those patients with CKD exhibited low levels of AST and ALT while the levels of ALP, GGT, and LDH were relatively higher. The levels of serum proteins were relatively lower in patients with CKD as compared to the control group. There is, therefore, the need for a keen interpretation of liver function tests in patients suffering from CKD.
Keywords:
Bilirubin, chronic kidney disease, liver enzymes, liver function tests, serum proteins,
References
-
Bargman, J.M. and K. Skorecki, 2008. Chronic kidney disease. In: Fauci, A.S., E. Braunwald, D.L. Kasper and S.L. Hauser (Eds.), Harrison's Principles of Internal Medicine. Mc Graw Hill, pp: 1761-1771.
Direct Link
-
Beddhu, S., X. Ma, B. Baird, A.K. Cheung and T. Greene, 2009. Serum alkaline phosphatase and mortality in African Americans with chronic kidney disease. Clin. J. Am. Soc. Nephrol., 4(11): 1805-1810.
CrossRef PMid:19729429 PMCid:PMC2774955
-
Blayney, M.J., R.L. Pisoni, J.L. Bragg-Gresham, J. Bommer, L. Piera et al., 2008. High alkaline phosphatase levels in hemodialysis patients are associated with higher risk of hospitalization and death. Kidney Int., 74(5): 655-663.
CrossRef PMid:18547993
-
Botev, R. and J.P. Mallie, 2008. Reporting the eGFR and its implication for CKD diagnosis. Clin. J. Am. Soc. Nephrol., 3(6): 1606-1607.
CrossRef PMid:18922981
-
Cain, L.R., A.M. Ducatman and A. Shankar, 2012. The relationship between gamma-glutamyl transferase levels and chronic kidney disease among Appalachian adults. W. V. Med. J., 108(1): 8-13.
Direct Link
-
Chen, T., Y. Ren, Y. Liu, Y. Long, X. Zhang, H. Yu et al., 2010. Serum gamma-glutamyl transferase, ferritin and the risk of type 2 diabetes in women from a Chinese minority. Diabetes Res. Clin. Pract., 90(3): 352-357.
CrossRef PMid:20970869
-
Eustace, J.A., B. Astor, P.M. Muntner, T.A. Ikizler and J. Coresh, 2004. Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease. Kidney Int., 65(3): 1031-1040.
CrossRef PMid:14871424
-
Fabrizi, F., P. Martin and P. Messa, 2010. Hepatitis B and hepatitis C virus and chronic kidney disease. Acta Gastroenterol. Belg., 73(4): 465-471.
Direct Link
-
Fabrizi, F., P., Martin, G. Lunghi and C. Ponticelli, 2001. Nosocomial transmission of hepatitis C virus infection in hemodialysis patients: Clinical perspectives. Int. J. Artif. Organs, 23(12): 805-816.
CrossRef PMid:11197739
-
Hrstic, I. and R. Ostojic, 2011. Chronic liver diseases in patients with chronic kidney disease. Acta Med. Croatica, 65(4): 349-353.
Direct Link
-
Kawamoto, R., K. Kohara, Y. Tabara, T. Kusunoki, N. Otsuka and T. Miki, 2008. Association between serum gamma-glutamyl transferase level and prehypertension among community-dwelling men. Tohoku J. Exp. Med., 216(3): 213-221.
CrossRef PMid:18987455
-
Kovesdy, C.P., V. Ureche, J.L. Lu and K. Kalantar-Zadeh, 2010. Outcome predictability of serum alkaline phosphatase in men with pre-dialysis CKD. Nephrol. Dial. Transplant., 25(9): 3003-3011.
CrossRef PMid:20299338 PMCid:PMC2948834
-
Kovesdy, C.P., 2012. Metabolic acidosis and kidney disease: Does bicarbonate therapy slow the progression of CKD? Nephrol. Dial. Transplant, 27(8): 3056-3062.
CrossRef PMid:22851628
-
Lopes, E.P., L.H. Sette, J.B. Sette, C.F. Luna, A.M. Andrade, M. Moraes et al., 2009. Serum alanine aminotransferase levels, hematocrit rate and body weight correlations before and after hemodialysis session. Clinics, 64(10): 941-945.
CrossRef
-
Lwanga, S.K., S. Lemeshow, W. David, Jr. Hosmer and K. Jannelle, 1986. Adequacy of sample size in healthy studies in epidemiological surveys. Bull. World Health Ooganiz., 15: 232-252.
-
Mohammadi-Karakani, A., S. Asgharzadeh-Haghighi, M. Ghazi-Khansari and R. Hosseini, 2007. Determination of urinary enzymes as a marker of early renal damage in diabetic patients. J. Clin. Lab. Anal., 21(06): 413-417.https://doi.org/10.1002/jcla.20212
CrossRef PMid:18022929
-
National Kidney Foundation, 2002. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am. J. Kid. Dis., 39: S1-266.
-
Ono, K., T. Ono and T. Matsumata, 1995. The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: The role of vitamin B6 deficiency. Clin. Nephrol., 43(6): 405-408.
Direct Link
-
Perico, N., D. Cattaneo, B. Bikbov and G. Remuzzi, 2009. Hepatitis C infection and chronic renal diseases. Clin. J. Am. Soc. Nephrol., 4(1): 207-220.
CrossRef PMid:19129320
-
Ray, L., S.K. Nanda, A. Chatterjee, R. Sarangi and S. Ganguly, 2015. A comparative study of serum aminotransferases in chronic kidney disease with and without end-stage renal disease: Need for new reference ranges. Int. J. Appl. Basic Med. Res., 5(1): 31-35.
CrossRef PMid:25664265 PMCid:PMC4318098
-
Regidor, D.L., C.P. Kovesdy and R. Mehrotra, 2008. High alkaline phosphatase predicts mortality among maintenance haemodialysis patients. Clin. J. Am. Soc. Nephrol., 19(11): 2193-2203.
CrossRef PMid:18667733 PMCid:PMC2573010
-
Ryu, S., Y. Chang, D.I. Kim, W.S. Kim and B.S. Suh, 2007. Gamma-Glutamyltransferase as a predictor of chronic kidney disease in nonhypertensive and nondiabetic Korean men. Clin. Chem., 53(1): 71-77.
CrossRef PMid:17110470
-
Sette, L.H. and E.P. Almeida Lopes, 2014. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: A comprehensive review. Clinics, 69(4): 271-278.
CrossRef
-
Sette, L.H. and E.P. Lopes, 2015. The reduction of serum aminotransferase levels is proportional to the decline of the glomerular filtration rate in patients with chronic kidney disease. Clinics, 70(5): 346-349.
CrossRef
-
Shantouf, R., C.P. Kovesdy, Y. Kim, N. Ahmadi, A. Luna et al., 2009. Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients. Clin. J. Am. Soc. Nephrol., 4(6): 1106-1114.
CrossRef PMid:19423565 PMCid:PMC2689878
-
Taliercio, J.J., J.D. Schold, J.F. Simon, S. Arrigain, A. Tang et al., 2013. Prognostic importance of serum alkaline phosphatase in CKD stages 3-4 in a clinical population. Am. J. Kidney Dis., 62(4): 703-710.
CrossRef PMid:23769134 PMCid:PMC3783514
Competing interests
The authors have no competing interests.
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