Various Patterns of the Derangement of Liver Function Tests in End-Stage Renal Disease Patients on Maintenance Hemodialysis-A Single Centered Study from Pakistan

Abstract

Background: Chronic kidney disease (CKD) patients on maintenance hemodialysis often present with various comorbidities, among which liver dysfunction is not uncommon. The prevalence of hepatitis B and C among this population suggests a multifaceted interaction between liver health and renal impairment. Studies have indicated that serum aminotransferase levels are inversely related to the severity of CKD and may be affected by hemodialysis. Objective: This study aimed to delineate the patterns and etiologies of liver function test derangements in an end-stage renal disease (ESRD) cohort on maintenance hemodialysis, assessing the association between dialysis duration and liver enzyme levels. Methods: In this cross-sectional observational study, 91 ESRD patients undergoing hemodialysis at a single center were evaluated. Liver function patterns were classified as hepatocellular, cholestatic, or mixed based on serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALKP), and gamma-glutamyl transferase (GGT). Statistical analysis was performed using SPSS version 25, with a significant p-value set at ≤ 0.05. Results: The average age of patients was 44 ± 15 years. The majority had been on dialysis for one (41.8%) or two years (33%). Hepatitis C (20.9%) was the predominant cause of viral hepatitis, followed by Hepatitis B (13.2%). Sepsis was identified as a major contributor to liver enzyme derangement (58.2%). The most common pattern of deranged liver enzymes was mixed (49.5%), followed by cholestatic (27.5%) and hepatocellular (23%). Elevated transaminases were noted, with AST at 227.8 ± 264.1 IU/mL and ALT at 237.1 ± 281.8 IU/mL. Conclusion: In the studied ESRD population, sepsis was the leading cause of liver dysfunction, with a higher incidence of mixed liver enzyme pattern derangements. The elevated aminotransferase levels contrast with previous studies, suggesting the need for enhanced infection control and consistent monitoring of liver health in the hemodialysis setting.