Impact of Decreased Serum Transaminase Levels on the Evaluation of Viral Hepatitis in Hemodialysis Patients

Vol. 69, No. 4, 1995

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Original Paper

Impact of Decreased Serum Transaminase Levels on the Evaluation of Viral Hepatitis in Hemodialysis Patients
Jinn-Yuh Guh^a, Yung-Hsiung Lai^a, Chi-Yuan Yang^b, Shinn-Cherng Chen^a, Wan-Long Chuang^a, Tzu-Chao Hsu^a, Hung-Chun Chen^a, Wen-Yu Chang^a, Juei-Hsiung Tsai^a

^aDepartment of Internal Medicine, Kaohsiung Medical College, Kaohsiung, and
^bSin-Lau Christian Hospital, Tainan, Taiwan

Address of Corresponding Author

Nephron 1995;69:459-465 (DOI: 10.1159/000188520)

Key Words

Hemodialysis
Transaminase
Hepatitis B
Hepatitis C

Abstract

The value of serum transaminases (ST) in evaluating hepatitis B (HBV) and C (HCV) infection was studied in 217 hemodialysis (HD) patients and 804 normal controls. Mean serum aspartate aminotransferase (AST) was 22.3 (22.0-22.7) and 22.6 (21.6-23.6) IU/1 or 0.371 (0.366-0.378) and 0.376 (0.36-0.393) µkat/1 in controls and HD patients, respectively (nonsignificant), while mean serum alanine aminotransferase (ALT) was 20.3 (19.9-20.7) and 16.3 (15.3-17.3) IU/1 or 0.338 (0.331-0.345) and 0.271 (0.255-0.288) µkat/1 in these two groups (p < 0.001). However, both AST and ALT became significantly depressed in HD patients after adjusting for age, gender, HBV surface antigen (HBsAg) and anti-HCV. The usual practice of regarding AST and ALT as being 'abnormal' in evaluating viral hepatitis when they exceeded the upper reference range (40 and 46 IU/1 or 0.666 and 0.766 µkat/1 in our laboratory) was then critically assessed by the receiver operating characteristic (ROC) curve. ROC analysis showed that ST was useless in detecting HBsAg, while the best cutoff point for detecting the presence of anti-HCV was 18 IU/1 (0.3 µkat/1) for AST and 16 IU/1 (0.266 µkat/1) for ALT in HD patients, respectively. These are considerably lower than the conventional criteria for an 'abnormal' ST. We conclude that ST are decreased in HD patients and that the cutoff value of ST for detecting HCV should be set at lower levels to enhance their diagnostic yield.

Author Contacts

Yung-Hsiung Lai, MD, Department of Internal Medicine, Kaohsiung Medical College, 100 Shi-Chuan 1st Rd, Kaohsiung (Taiwan)

Article Information

Accepted: July 13, 1994
Published online: December 17, 2008
Number of Print Pages : 7

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