Hypoaminotransferasemia in patients undergoing long-term hemodialysis: Clinical and biochemical appraisal

Abstract

Background & Aims : It has been reported that patients with chronic renal failure have low serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels as a result of vitamin B 6 deficiency. Chronic hepatitis C is common among patients undergoing hemodialysis, and low aminotransferase levels cause diagnostic problems. The aim of this study was to determine the cause of hypoaminotransferasemia. Methods : Serum levels of vitamin B 6 and its coenzyme were reassessed in relation to AST and ALT levels in patients undergoing long-term hemodialysis using high-performance liquid chromatography. Results : The mean (±SD) serum AST and ALT levels in 304 patients negative for hepatitis B surface antigen and anti-hepatitis C virus were 9.2 ± 2.4 and 7.4 ± 1.7 IU/L, respectively. In 556 normal adults, they were 22.7 ± 5.4 and 18.0 ± 4.0 IU/L, respectively ( P < 0.001). Mean serum vitamin B 6 and pyridoxal-5′-phosphate levels in patients undergoing dialysis were not reduced compared with the control, although occasionally patients had low levels. The AST and ALT assay reagents in Japan do not contain added pyridoxal-5′-phosphate; addition of pyridoxal-5′-phosphate (0.1 mmol/L) to the reagent significantly increased measurements to similar extents in both groups. Conclusions : Serum AST and ALT levels in patients undergoing dialysis are very low, but they are not a result of vitamin B 6 deficiency. The upper normal limits of AST and ALT levels in patients undergoing dialysis should be reduced considerably, and these levels should be interpreted with caution in the diagnosis of liver disease.