Serum Liver and Pancreatic Enzymes in Chronic Kidney Disease with and without End-stage Renal Disease: A Comparative Study
M Manju, Suryapriya Rajendran, Sasmita Mishra, Pavithra M
Chronic kidney disease, GFR, Hepatic and pancreatic enzymes
Citation Information :
Manju M, Rajendran S, Mishra S, M P. Serum Liver and Pancreatic Enzymes in Chronic Kidney Disease with and without End-stage Renal Disease: A Comparative Study. Indian J Med Biochem 2019; 23 (1):207-212.
Introduction: Chronic kidney disease (CKD) is emerging as an important chronic disease globally. The occurrence of liver and pancreatic diseases as comorbid conditions is very common. Estimation of liver and pancreatic enzymes still remains the main modality of diagnosis and monitoring hepatic and pancreatic diseases. Alterations in the enzyme levels in the absence of liver and pancreatic diseases have been reported. Hence we decided to compare the serum levels of liver and pancreatic enzymes (AST, ALT, ALP, GGT amylase and lipase) among CKD patients without end-stage renal disease (ESRD), patients with ESRD and healthy controls and to correlate the enzyme levels with eGFR (severity).
Materials and methods: The present study was conducted in a tertiary care hospital with 100 controls, 100 CKD patients without ESRD and 100 ESRD patients. All the 300 patients had no evidence of hepatic or pancreatic diseases. Alanine transaminase (AST), aspartate transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), amylase and lipase were estimated in all 300 study subjects.
Results: There was a significant decrease in the levels of AST and ALT and increase in ALP, GGT, amylase and lipase levels in the CKD patients without ESRD and ESRD patients as compared to the controls (p < 0.05). eGFR was found to have a strong negative correlation with ALP, amylase, and lipase in CKD patients without ESRD and with ESRD.
Conclusion: Our study emphasizes that, using the present reference ranges for these enzymes in CKD patients will result misdiagnosis of hepatic or pancreatic disease, hence emphasizing the need to establish new reference ranges for these enzymes in various stages of CKD which ultimately will help the treating physicians in diagnosis and management of hepatic and pancreatic dysfunction in CKD patients.
Rajapurkar MM, John GT, Kirpalani AL, et al. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol 2012;13:10.
Anupama YJ, Uma G. Prevalence of chronic kidney disease among adults in a rural community in South India: Results from the kidney disease screening (KIDS) project. Indian J of Nephrol 2014;24(4): 214- 221.
Verma PP. Prevalence of chronic kidney disease in India - Where are we heading? Indian J Nephrol 2011; 25(3):133-135.
KDOQI. Chronic Kidney Disease: Evaluation, Classification, and Stratification.2002.
Kdoqi clinical practice guideline for hemodialysis adequacy: 2015 update.
Hsu CY, Vittinghoff E, Lin F, et al. The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency. Ann. Intern. Med. 2004;141:95-101
Hrstic I, Ostojic R. Chronic liver diseases in patients with chronic kidney disease. Acta Med Croatica 2011, 65: 349-353.
Wreghitt TG. Blood-borne virus infections in dialysis units--a review. Rev Med irol 1999;9:101-109.
Chan TM, Lok AS, Cheng IK, et al. Prevalence of hepatitis C virus infection in hemodialysis patients: a longitudinal study comparing the results of RNA and antibody assays. Hepatology. 1993;17: 5-8.
Paul G. Lankisch, Bettina Weber-Dany, Patrick Maisonneuve and Albert B. Lowenfels. Frequency and severity of acute pancreatitis in chronic dialysis patient Nephrol Dial Transplant 2008;23: 1401-1405s.
Ray L, Nanda SK, Chatterjee A, et al. A comparative study of serum aminotransferases in chronic kidney disease with and without endstage renal disease: Need for new reference ranges. Int J Appl Basic Med Res 2015;5:31-35.
Bindu CM, Shankar V, Shetty PHV, et al. Serum amylase in patients with chronic kidney disease. IJCRR 2013; 5(17):10-15.
Cohen GA, Goffinet JA, Donabedian RK, et al. Observations on decreased serum glutamic oxalacetic transaminase (SGOT) activity in azotemic patients. Ann Intern Med 1976;84:275.
Nanji AA. Decreased activity of commonly measured serum enzymes: causes and clinical significance. Am J Med Technol 1983;49:241.
Guh JY, Lai YH, Yang CY, et al. Impact of decreased serum transaminase levels on the evaluation of viral hepatitis in hemodialysis patients. Nephron 1995; 69:459.
Fabrizi F, Lunghi G, Finazzi S, et al. Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis. Am J Kidney Dis 2001; 38:1009.
Hung KY, Lee KC, Yen CJ, Wu KD, et al. Revised cutoff values of serum aminotransferase in detecting viral hepatitis among CAPD patients: Experience from Taiwan, an endemic area for hepatitis B. Nephrol Dial Transplant 1997;12:180.183.
Al. Wakeel J, Malik GH, al. Mohaya S, Mitwalli A, Baroudi F, el Gamal H, et al. Liver disease in dialysis patients with antibodies to hepatitis C virus. Nephrol Dial Transplant 1996;11:2265.2268
Yuki N, Ishida H, Inoue T, Tabata T, Matsushita Y, Kishimoto H, et al. Reappraisal of biochemical hepatitis C activity in hemodialysis patients. J Clin Gastroenterol 2000;30:187.194.
Hamfelt A. The effect of pyridoxal phosphate on the aminotransferase assay in blood. Scand J Clin Lab Invest Suppl 1966;18:92:181.
Ono K, Ono T, Matsumata T. The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: The role of vitamin B6 deficiency. Clin Nephrol 1995;43:405.408.
Freethi R, Raj AV, Ponniraivan K, Khan MR, et al. Study of serum levels of calcium, phosphorus and alkaline phosphatase in chronic kidney disease. Int J Med Res Health Sci 2016;5(3):49-56
Ray L, Nanda SK, Chatterjee A, et al. A comparative study of serum aminotransferases in chronic kidney disease with and without end.stage renal disease: Need for new reference ranges. International Journal of Applied and Basic Medical Research. 2015;5(10):31-35.
Jiang CF, Ng KW, Tan SW, et al. Serum level of amylase and lipase in various stages of chronic renal insufficiency. Zhonghua Yi Xue Za Zhi(Taipei) 2002;65:49-54.
Collen MJ, Ansher AF, Chapman AB, et al. Serum amylase in patients with renal insufficiency and renal failure. Am J Gastroenterol 1990; 85:1377.
Vaziri ND, Chang D, Malekpour A, et al. Pancreatic enzymes in patients with end-stage renal disease maintained on hemodialysis. Am J Gastroenterol 1988;83:410.