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Abstract Serum aninotransferase values are somemnes depressed (e.g. by IQ-. 20%) in 1O~90%of dialysis patieats, Many expJanations have been advaaced, including inhibition of transamilllase activity by uremic toxins and deficiency of pyridoxal phosphate (Chang et at.. J 976). Serum AST values have been shown, to increase after dialysis; the lncrease is presumed to be due to either to removal of diblyzable inhibitor or increased release of the enzyme from erythrocytes in the extraeorpoeeal cu-culatiOJ:\ (Cohen. 1976). Because of the low baseline serum mniootransferase levels in dialysis patients, the finding ora value slightly above the upper limits of Donnat, or of a substantial rise within the llOllDal range, sbould alert the clinician to a possible underlying disease process (MandeJli, J 991). A commonelimcal problem is to evaluate the importance of mildly elevated anlinotrans€erase levels in a dialysis patient. The elevated aminotransferase levels in dialysis patients must be considered to reOeer possible viral hepatitis (B andlor C) until proved otherwise, herpes simplex hepatitis, adenovirus hepatitis or CytOlllCgalOMS hepatitis also will present with etevatedaminotransferases (AST > ALT). Other causes of elevation of theseenzyme.s include the effect of hepatotoxic drugs aad iron overload as reflected by high serum ferritin level (Stanbo-ug/t 1984). |