Association of aspartate aminotransferase with mortality in hemodialysis patients

Vanessa Ravel, Elani Streja, Miklos Z. Molnar, Sepideh Rezakhani, Melissa Soohoo, Csaba P. Kovesdy, Kamyar Kalantar-Zadeh, Hamid Moradi

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6 Citations (Scopus)

Abstract

BackgroundLiver disease is a common comorbid condition in maintenance hemodialysis (MHD) patients and may be associated with poor survival. The relationship between aspartate aminotransferase (AST) and survival has not yet been addressed in these patients. We hypothesized that higher AST level is associated with higher death risk in MHD patients. MethodsA 5-year (January 2007-December 2011) cohort of 109 718 MHD patients was studied in the USA in dialysis clinics where AST was measured in at least 50% of all outpatients in the baseline calendar quarter. Survival models were adjusted for demographic variables, and available clinical and laboratory surrogates of malnutrition-inflammation complex, and cubic survival splines were plotted. ResultsA linear association existed between baseline serum AST levels and mortality. Increasing AST of >20 IU/L was incrementally and almost linearly associated with higher death risk at all levels of adjustment. In fully adjusted models, AST levels of ≥40 IU/L were associated with the highest risk of mortality (hazard ratio: 1.46, 95% CI: 1.38-1.54). Low AST levels (<15 IU/L) were associated with increased death risk only in fully adjusted models examining hepatitis C virus-positive patients. ConclusionsHigher AST level of >20 IU/L is incrementally associated with higher mortality in MHD patients whereas AST in the 15-20 IU/L range is associated with the greatest survival. These findings suggest that the assessment of liver function and improving liver disease may confer survival benefit to MHD patients.

Original languageEnglish
Pages (from-to)814-822
Number of pages9
JournalNephrology Dialysis Transplantation
Volume31
Issue number5
DOIs
Publication statusPublished - May 1 2016

Keywords

  • all-cause mortality
  • aspartate aminotransferase
  • end-stage renal disease
  • hemodialysis
  • liver enzymes

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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  • Cite this

    Ravel, V., Streja, E., Molnar, M. Z., Rezakhani, S., Soohoo, M., Kovesdy, C. P., Kalantar-Zadeh, K., & Moradi, H. (2016). Association of aspartate aminotransferase with mortality in hemodialysis patients. Nephrology Dialysis Transplantation, 31(5), 814-822. https://doi.org/10.1093/ndt/gfv310