TO STUDY THE CLINICAL, BIOCHEMICAL, SEROLOGICAL AND RADIOLOGICAL HEPATIC PROFILE IN PATIENTS OF CHRONIC KIDNEY DISEASE ON MAINTENANCE HEMODIALYSIS

Main Article Content

Dr Karwa Mohit Brijmohan
Dr Vivek Ahuja
Dr Sudhir Mehta
Dr Aakash Aggarwal

Keywords

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Abstract

Background: Chronic kidney disease (CKD) is a silent epidemic of the 21st century. Although the connection between the kidney and liver is well recognized and intricate, it is still not entirely understood. Hepatic disorders in CKD may range from mild form of transaminitis to life threatening decompensated chronic liver disease. Many of these manifestations may have correctable underlying etiologies.


 


Aim & Objective: To study the spectrum of clinical, hepatic biochemical, serological and radiological profile in patients of CKD on maintenance hemodialysis (HD).


 


Methodology: The present study was a prospective observational study which was conducted in the Department of Gastroenterology, MMIMSR, Mullana from January 2023 to January 2024 with a sample size of 100 patients. All indoor and outdoor cases of CKD were enrolled for the study and screened for various hepatic complaints. Written informed consent and institutional ethical clearance was obtained in all the cases. Complete anonymity of the patient was maintained in all the cases. All the selected patients were subjected to various biochemical, serological, and radiological investigations.


 


Results: The mean age of subjects was 55.5 years. 71% were male and 29% were female. The most common etiology of CKD was systemic arterial hypertension (39%). During serological examination, 16% were positive for Anti HCV Ab while 11% were positive for HBsAg and only 2% were positive for HIV. It was observed that AST (SGOT), ALT (SGPT), GGT and Serum albumin mean values were on lower side in patients of CKD on maintenance HD. On Ultrasonography, 40% subjects had normal liver while 29% had Grade 1 fatty liver, 15% had Grade 2 fatty liver, 2% had Grade 3 fatty liver and 14% had chronic liver disease.


Conclusion: In summary, our study reinforces that hepatic disease is common and manifests in multiple ways in CKD subjects, likely due to the intricate interplay between liver and kidney functions. CKD potentially initiates and exacerbates early stages of hepatic disease, progressing to more severe states. A comprehensive, interdisciplinary approach is essential, necessitating collaboration between hepatologists and nephrologists for timely and effective management of these patients.

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References

Schnaper HW. Remnant nephron physiology and the progression of chronic kidney disease. Pediatr Nephrol. 2014 Feb;29(2):10.1007/s00467-013-2494–8.
2. Chronic kidney disease: global dimension and perspectives. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B. Lancet. 2013;382:260–272.
3. Varma PP. Prevalence of chronic kidney disease in India - Where are we heading? Indian J Nephrol. 2015;25(3):133–5.
4. Chronic kidney disease: whom to screen and how to treat, part 1: definition, epidemiology, and laboratory testing. Brosnahan G, Fraer M. https://pubmed.ncbi.nlm.nih.gov/20065899/ South Med J. 2010;103:140–146.
5. Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017 Mar 25;389(10075):1238-1252.
6. Yu HT. Progression of chronic renal failure. Arch Intern Med. 2003 Jun 23;163(12):1417-29.
7. Sachdeva B, Zulfiqar H, Aeddula NR. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Peritoneal Dialysis.
8. Junghare MY, Ibrahim HN. Chapter 45 - Chronic Kidney Disease and Liver Disease. In: Kimmel PL, Rosenberg ME, editors. Chronic Renal Disease [Internet]. San Diego: Academic Press; 2015 [cited 2023 May 12]. p. 544–59. Available from:
https://www.sciencedirect.com/science/article/pii/B9780124116023000457
9. Sette LHBC, de Almeida Lopes EP. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review. Clinics (Sao Paulo). 2014 Apr;69(4):271–8.
10. Crawford DR, Reyna RS, Weiner MW. Effects of in vivo and in vitro dialysis on plasma transaminase activity. Nephron. 1978;22(4–6):418–22.
11. 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 Jun;43(6):405–8.
12. Jung K, Mildner D, Jacob B, Scholz D, Precht K. On the pyridoxal-5’-phosphate stimulation of aspartate aminotransferase and alanine aminotransferase in serum and erythrocytes of patients undergoing chronic haemodialysis and with kidney transplants. Clin Chim Acta. 1981 Sep 10;115(2):105–10.
13. Gressner AM, Sittel D. Plasma pyridoxal 5’-phosphate concentrations in relation to apo-aminotransferase levels in normal, uraemic, and post-myocardial infarct sera. J Clin Chem Clin Biochem. 1985 Oct;23(10):631–6.
14. Sombolos KI, Fragidis SK, Bamichas GI, Hatsiou VN, Bantis CK, Tsantekidou HS, et al. Dogma disputed: postdialysis increase of aminotransferase values cannot be attributed to an inhibitor removal by hemodialysis. ASAIO J. 2012;58(6):612–5.
15. Fabrizi F, Lunghi G, Finazzi S, Colucci P, Pagano A, Ponticelli C, et al. Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis. Am J Kidney Dis. 2001 Nov;38(5):1009–15.
16. Azmi AN, Tan SS, Mohamed R. Hepatitis C and kidney disease: An overview and approach to management. World J Hepatol. 2015 Jan 27;7(1):78–92.
17. Fabrizi F, Messa P, Basile C, Martin P. Hepatic disorders in chronic kidney disease. Nat Rev Nephrol. 2010 Jul;6(7):395–403.
18. Cotler SJ, Diaz G, Gundlapalli S, Jakate S, Chawla A, Mital D, et al. Characteristics of hepatitis C in renal transplant candidates. J Clin Gastroenterol. 2002 Aug;35(2):191–5.
19. Badalamenti S, Catania A, Lunghi G, Covini G, Bredi E, Brancaccio D, et al. Changes in viremia and circulating interferon-alpha during hemodialysis in hepatitis C virus-positive patients: only coincidental phenomena? Am J Kidney Dis. 2003 Jul;42(1):143–50.
20. Gouveia EC, Lopes EPA, Moura I, Cruz M, Kosminsky L, Pernambuco JR. Identification of the cutoff value for serum alanine aminotransferase in hepatitis C screening of patients with chronic renal failure on hemodialysis. Rev Soc Bras Med Trop. 2004;37(1):18–21.
21. Lopes EP, Sette LHBC, Sette JBC, Luna CF, Andrade AM, Moraes M, et al. Serum Alanine Aminotransferase Levels, Hematocrit Rate and Body Weight Correlations Before and After Hemodialysis Session. Clinics (Sao Paulo). 2009 Oct;64(10):941–5.
22. Fabrizi F, Mangano S, Alongi G, Bisegna S, Finazzi S, Lunghi G, et al. Influence of hepatitis B virus virema upon serum aminotransferase activity in dialysis population. Int J Artif Organs. 2003 Dec;26(12):1048–55.
23. Li H, Wang SX. Hepatitis C viral infection in a Chinese hemodialysis unit. Chin Med J (Engl). 2010 Dec;123(24):3574–7.
24. Liu CH, Liang CC, Liu CJ, Hsu SJ, Lin JW, Chen SI, et al. The ratio of aminotransferase to platelets is a useful index for predicting hepatic fibrosis in hemodialysis patients with chronic hepatitis C. Kidney Int. 2010 Jul;78(1):103–9.
25. Schiavon LL, Schiavon JLN, Filho RJC, Sampaio JP, Lanzoni VP, Silva AEB, et al. Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection. Hepatology. 2007 Aug;46(2):307–14.
26. Fabrizi F, De Vecchi AF, Qureshi AR, Aucella F, Lunghi G, Bruchfeld A, et al. Gamma glutamyltranspeptidase activity and viral hepatitis in dialysis population. Int J Artif Organs. 2007 Jan;30(1):6–15.
27. Liberato IR de O, Lopes EP de A, Cavalcante MAG de M, Pinto TC, Moura IF, Loureiro Júnior L. Liver enzymes in patients with chronic kidney disease undergoing peritoneal dialysis and hemodialysis. Clinics. 2012;67:131–4.
28. Mikolasevic I, Racki S, Bubic I, Jelic I, Stimac D, Orlic L. Chronic kidney disease and nonalcoholic Fatty liver disease proven by transient elastography. Kidney Blood Press Res. 2013;37(4–5):305–10.