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

Yasuda, Kazuto; Okuda, Kunio; Endo, Noriko; Ishiwatari, Yukihisa; Ikeda, Ritsuko; Hayashi, Haruyuki; Yokozeki, Kazuo; Kobayashi, Susumu; Irie, Yasubumi

doi:10.1016/0016-5085(95)90591-x

Cited by 139 publications

(95 citation statements)

References 21 publications

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“…Low ALT levels were found to be a biomarker for increased frailty and subsequent increased risk of mortality in old age 1,2 and among chronic kidney disease [CKD] patients treated with hemodialysis. 3,4 Frailty, as a qualitative definition, currently diagnosed by several indices, 5 is thought to be associated with decreased skeletal muscle mass. 1,6,7 Therefore, it is plausible to assume that low ALT levels are associated with sarcopenia.…”

Section: Introductionmentioning

confidence: 99%

Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients

et al. 2015

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BACKGROUND: Low alanine aminotransferase (ALT) blood levels are known to be associated with frailty and increased risk of long-term mortality in certain populations. However, the contribution of this marker to longterm outcome has not been assessed in patients with chronic coronary heart disease. OBJECTIVE: The aim of the current study was to assess the association between low ALT values and long-term, 22.8-year, all-cause mortality in this population. PARTICIPANTS: We examined the association of low ALT (<17 IU/l) with long-term all-cause mortality in the Bezafibrate Infarction Prevention (BIP) Registry population. KEY RESULTS: Appropriate laboratory and survival data were available for 6,575 patients, without known liver pathology, included in the BIP registry, with a median follow-up period of 22.8 years. The cumulative probability of all-cause mortality was significantly higher in the low ALT group compared with patients with higher ALT levels (65.6 % vs. 58.4 %; log-rank p<0.001). Consistently, multivariate analysis, adjusted for multiple established predictors of mortality in this population, demonstrated that low ALT is independently associated with 11 % greater long-term (22.8 years) mortality risk [HR 1.11 (95 % confidence interval: 1.03-1.19; adjusted p<0.01)]. CONCLUSIONS: Low ALT levels are associated with increased long-term mortality among middle-aged patients with stable coronary heart disease. This association remained statistically significant after adjustment for other well-established risk factors for mortality in this population.

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Section: Introductionmentioning

confidence: 99%

Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients

et al. 2015

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“…3,4 Routine serologic controls performed biannually (including qualitative PCR technology) and testing at least every 2 mo for alanine aminotransferase (ALT) and ␥-glutamyl transpeptidase (␥-GTP) levels are important for monitoring viral hepatitis transmission within HD units. 5,6 When ALT values are Ͼ28 IU/L (upper normal limit for hemodialysis patients) [7][8][9] and/or ␥-GTP levels are increased (Ͼ43 IU/L), viral markers (hepatitis B surface antigen and DNA, anti-HCV, and HCV-RNA) and nonviral causes of liver disease (e.g., autoimmunity, toxic hepatitis, metabolic disorders) are studied to identify the cause of the elevated liver enzymes; however, the cause of liver disease cannot be established in approximately 2% of HD patients (personal observation).…”

mentioning

confidence: 99%

Occult Hepatitis C Virus Infection among Hemodialysis Patients

Barril

Castillo

Arenas

et al. 2008

Journal of the American Society of Nephrology

105

106

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“…Beside the routine liver tests, 7S domain type IV collagen was measured as an indirect indicator of hepatic fibrosis in dialysis cases [9,10] . The disease activities were graded into three categories: "asymptomatic" if ALT levels remained below 40 IU/L for the control group and below 35 IU/L for dialysis cases, the difference in the upper normal limit was due to normally low ALT and AST in dialysis patients [11,12] ; "low activities" if ALT fluctuated between 35 (40 in control) and 79 IU/L; and "high activities" if ALT levels exceeded 80 IU/L during the last 4 year period.…”

Section: Methodsmentioning

confidence: 99%

“…It is not known whether Cviruses are able to replicate in liver cells of immunologically compromised dialysis patients as in immunologically competent individuals. Hepatocytes of the dialysis patients might not have normal metabolic and synthetic capabilities under the influence of uremic state, as exemplified by very low AST and ALT levels in serum [11,12] . Replication of viral particles within hepatocytes might be reduced for the same reason.…”

Section: Discussionmentioning

confidence: 99%

Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up

Okuda¹,

Yokosuka²

2004

WJG

Self Cite

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AIM: Hepatitis C virus (HCV) infection is very common among end-stage kidney disease patients on hemodialysis, but its natural history is not known. METHODS:In this study, 189 dialysis patients (case) positive for HCV antibodies who were followed up for more than 4 years were compared with twice as many sex/age matched controls with chronic hepatitis C who were diagnosed in the same month as the case and followed up for comparable periods. The longest follow-up was 23 years in dialysis cases. The disease activities were graded into "asymptomatic" if ALT was less than 40 (35 in cases) IU/L, "low activities" if ALT was 40 (35)-79 IU/L, and "high activities" if ALT was above 80 IU/L during the last or latest 4 year period. RESULTS:All 25 dialysis cases who were followed up for more than 15 years were asymptomatic and 15 of them were negative for HCV RNA. Of the 50 controls followed up for more than 15 years, 34 had high activities, and none cleared HCV RNA. There were 60 controls who were asymptomatic, but they were all positive for HCV RNA, while 22.3% of asymptomatic dialysis cases were RNA negative. No dialysis patients with chronic hepatitis C progressed to cirrhosis, whereas the disease progressed to cirrhosis in more than one quarter of the controls. These differences were highly significant (P<0.0001).

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

Cited by 139 publications

References 21 publications

Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients

Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients

Occult Hepatitis C Virus Infection among Hemodialysis Patients

Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up

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