Patterns of Liver Function Test Derangements in End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Single-Center Study from Pakistan

Abstract

Background: Patients with end-stage renal disease (ESRD) on maintenance hemodialysis frequently exhibit abnormal liver function tests (LFTs). These derangements can complicate the management of ESRD and contribute to increased morbidity. This study aimed to identify and characterize the patterns of LFT abnormalities and their associated factors in ESRD patients on maintenance hemodialysis at Avicena Hospital, Lahore.

Objective: The objective of this study was to investigate the prevalence and patterns of LFT derangements in ESRD patients on maintenance hemodialysis and to identify potential contributing factors to these abnormalities.

Methods: It is a cross-sectional study conducted at Avicena Hospital, Lahore, from April 2022 to September 2022. A total of 34 cases of ESRD patients on maintenance hemodialysis were taken in this series. Patients were included if they were above 18 years of age, diagnosed with ESRD and on regular hemodialysis for the last 3 months. Excluded patients were those with acute liver failure, liver transplant patients, and incomplete medical records. Data were collected through the review of medical records for demographic data and duration on hemodialysis, comorbidities, medication history, and LFTs that include the ALT, AST, ALP, total bilirubin levels, and serum albumin levels. Collection of serologies of Hepatitis B and C was also taken. Management Analysis was done in SPSS version 25, and the analysis was treated descriptively after entering the parameters of the data. The presence of abnormalities of LFT was evaluated, and the relationship between LFT derangements and possible risk factors was tested using chi-square tests and t-tests; those occurring below a p-value of 0.05 were considered statistically significant.

Results: The study population had a mean age of 55.2 ± 12.3 years, with 58.8% males and 41.2% females. The mean duration of hemodialysis was 36.5 ± 14.2 months. Hepatitis B and C were present in 14.7% and 20.6% of the patients, respectively. The mixed pattern of LFT derangements was observed in 50.0% of patients, characterized by elevations in both ALT (45.6 ± 20.3 U/L) and AST (48.7 ± 22.1 U/L). The cholestatic pattern was found in 29.4% of patients, marked by increased ALP (110.2 ± 40.5 U/L) and total bilirubin (1.8 ± 0.7 mg/dL). The hepatocellular pattern was identified in 20.6% of patients, indicated by elevated ALT levels. Chronic inflammation (58.8%), malnutrition (47.1%), and hepatotoxic medications (41.2%) were significant contributing factors to liver dysfunction.

Conclusion: Liver function test derangements are common among ESRD patients on maintenance hemodialysis, with the mixed pattern being the most prevalent. Chronic inflammation, viral hepatitis, malnutrition, and hepatotoxic medications are significant contributors to these abnormalities. Regular monitoring and targeted interventions are essential to manage liver dysfunction and improve patient outcomes in this population.