A Comprehensive Study on the Alterations in Liver Enzyme and Pancreatic Enzyme Levels among Patients with Chronic Kidney Disease

Background: Chronic kidney disease (CKD) is a growing global health concern, and the occurrence of liver and pancreatic diseases as comorbid conditions in this patient population is very common. The primary aim of this study is to estimate the serum levels of liver and pancreatic enzymes in CKD patients in the absence of hepatobiliary disease and pancreatitis. Methods: The present descriptive comparative study includes 200 chronic kidney disease patients of both sexes obtained from Apollo Medical College, Andhra Pradesh. The subjects were divided into five groups – 40 stage I CKD patients; 40-stage II CKD patients; 40-stage III CKD patients; 40-stage IV CKD patients; 40-stage V CKD pre and postdialysis. The present study aims to estimate changes in serum levels of liver enzymes Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP) levels, and pancreatic enzymes amylase and lipase levels in I, II, III, and IV, and pre- and postdialysis of the V stage of CKD patients. The study also includes a comparison of various parameters of enzymes in five study groups of CKD patients, followed by correlation analysis of estimated glomerular filtration rate (eGFR) with liver and pancreatic enzymes in all four stages of CKD and pre- and postdialysis of the V th stage. Results: The study result showed a significant decrease in the levels of AST and ALT and significant increase in ALP, amylase and lipase levels in the stage II, III, and IV as compared to the stage I and significant decrease in levels of AST, ALT, ALP in postdialysis compared to pre dialysis and amylase and lipase levels increased in postdialysis compared to pre dialysis. The severity of CKD is directly proportional to the degree of increase in serum ALP, Amylase, and lipase levels. The estimated eGFR levels have a strong negative correlation with ALP, amylase, and lipase in all CKD stages. Conclusion: Our study reinforces that serum amino transferase levels tend to remain low in CKD patients and levels are further reduced in CKD with end-stage renal disease. The patients on hemodialysis (HD) had increased levels of serum amylase and lipase in post-HD, which was probably due to an increase in lipoprotein lipase released from endothelial cells of capillaries. Clinical relevance: Alterations in liver and pancreatic enzyme levels are common in CKD. Regular monitoring of these biomarkers may improve early detection, diagnostic accuracy, and clinical management in CKD patients.