ASSESSMENT OF COMPLETE BLOOD COUNT AND LIVER ENZYMES IN CHRONIC KIDNEY DISEASE PATIENT

A SHAFIQUE; H JAVAID; H BAJWA; R ANWAR; M YASEEN; . SANA

doi:10.54112/bcsrj.v2024i1.746

Authors

A SHAFIQUE Department of Allied Health Sciences, College of Rehabilitation Sciences, Government College University Faisalabad, Pakistan
H JAVAID Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University Faisalabad, Pakistan
H BAJWA College of Allied Health Sciences, Government College University, Faisalabad, Pakistan
R ANWAR Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University Faisalabad, Pakistan
M YASEEN Department of Allied Health Sciences, College of Rehabilitation Sciences, Government College University Faisalabad, Pakistan
. SANA College of Allied Health Sciences, Government College University, Faisalabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.746

Keywords:

Chronic Kidney Disease, Blood Cell Count, Liver Enzymes, Glomerular Filtration Rate

Abstract

Chronic renal failure (CRF) poses a significant global health challenge, with chronic kidney disease (CKD) characterised by kidney damage or a glomerular filtration rate (GFR) persistently below 60 ml/min for over three months. This observational study, conducted in Faisalabad from January to July 2023, aimed to evaluate haematological variables and liver enzymes across different stages of CKD. Using non-probability purposive sampling, 144 CKD patient files and 48 healthy control files were collected, excluding specific conditions. CKD staging was determined using the Modification of Diet in Renal Disease (MDRD) algorithm, categorizing patients into mild (Group A), moderate (Group B), severe (Group C) CKD, and controls (Group D). Data analysis was performed using SPSS v23. Mean ± SD values were presented for each parameter across the four groups. Haemoglobin levels (Hb g/dl) exhibited a decreasing trend in CKD patients compared to the control group, with values of 13.7 ± 1.50 in controls, 11.7 ± 0.64 in Group 1, 9.7 ± 0.57 in Group 2, and 6.7 ± 1.5 in Group 3. Red blood cell count (RBCs per million/mm3) also decreased progressively in CKD patients compared to controls, with values of 5.48 ± 0.59, 4.62 ± 0.15, 3.57 ± 0.28, and 2.81 ± 0.23 in the respective groups. Conversely, white blood cell counts (WBC thousand/mm3) increased with CKD progression, showing values of 8406 ± 1383 in controls, 10674 ± 1006 in Group 1, 12028 ± 643.5 in Group 2, and 13564 ± 741.29 in Group 3. Similarly, platelet counts (lakh/ul) exhibited a decreasing trend in CKD patients compared to controls, with values of 324708 ± 112970, 235458 ± 63853, 144979 ± 6935.8, and 126333 ± 4768.3, respectively. Analysis of liver enzymes revealed a progressive decrease in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels as CKD advanced. AST levels (U/L) decreased from 29.104 ± 3.130 in controls to 7.5825 ± 1.543 in Group 3, while ALT levels (U/L) decreased from 48.145 ± 4.9679 in controls to 12.270 ± 3.3500 in Group 3. Our findings demonstrate that haemoglobin, red blood cell count, platelet count, and liver enzyme levels (AST and ALT) decrease as CKD progresses while white blood cell count increases. These insights into haematological and hepatic biomarkers underscore the dynamic nature of CKD pathology and may inform clinical management strategies.

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References

Abubakar, I., Tillmann, T., & Banerjee, A. J. L. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. 385(9963), 117-171.

Al-Wakeel, J., Malik, G., Al-Mohaya, S., Mitwalli, A., Baroudi, F. e., El Gamal, H., & Kechrid, M. J. N. D. T. (1996). Liver disease in dialysis patients with antibodies to hepatitis C virus. 11(11), 2265-2268.

Alam, A., Amanullah, F., Baig-Ansari, N., Lotia-Farrukh, I., & Khan, F. S. J. B. r. n. (2014). Prevalence and risk factors of kidney disease in urban Karachi: baseline findings from a community cohort study. 7(1), 1-11.

Alebiosu, C., Ayodele, O. J. E., & disease. (2005). The global burden of chronic kidney disease and the way forward. 15(3), 418-423.

Alghythan, A. K., & Alsaeed, A. H. (2012). Hematological changes before and after hemodialysis. Scientific Research and Essays, 7(4), 490-497.

Badalamenti, S., Catania, A., Lunghi, G., Covini, G., Bredi, E., Brancaccio, D., . . . Graziani, G. (2003). Changes in viremia and circulating interferon-α during hemodialysis in hepatitis C virus-positive patients: only coincidental phenomena? American Journal of Kidney Diseases, 42(1), 143-150.

BROWN, G. E., & Roth, G. M. J. A. o. I. M. (1922). The anemia of chronic nephritis. 30(6), 817-840.

Chandrasekhar, M. Hematological Changes in Chronic Renal Failure.

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management: a review. Jama, 322(13), 1294-1304.

Cotler, S. J., Diaz, G., Gundlapalli, S., Jakate, S., Chawla, A., Mital, D., . . . Jensen, D. M. J. J. o. c. g. (2002). Characteristics of hepatitis C in renal transplant candidates. 35(2), 191-195.

De Broe, M., & Delanaye, P. J. K. I. (2020). How to interpret an estimated glomerular filtration rate (eGFR) in 2020? , 98(5), 1090-1092.

Eschbach Jr, J., Funk, D., Adamson, J., Kuhn, I., Scribner, B., & Finch, C. J. N. E. J. o. M. (1967). Erythropoiesis in patients with renal failure undergoing chronic dialysis. 276(12), 653-658.

Fabrizi, F., Lunghi, G., Finazzi, S., Colucci, P., Pagano, A., Ponticelli, C., & Locatelli, F. J. A. j. o. k. d. (2001). Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis. 38(5), 1009-1015.

Gafter, U., Bessler, H., Malachi, T., Zevin, D., Djaldetti, M., & Levi, J. J. N. (1987). Platelet count and thrombopoietic activity in patients with chronic renal failure. 45(3), 207-210.

Gallagher, P., Glader, B. J. W. s. C. H. t. e. P. L. W., & Wilkins. (2009). Hereditary spherocytosis, hereditary elliptocytosis, and other disorders associated with abnormalities of the erythrocyte membrane. 912-930.

George, C., Matsha, T. E., Erasmus, R. T., & Kengne, A. P. (2018a). Haematological profile of chronic kidney disease in a mixed-ancestry South African population: a cross-sectional study. BMJ open, 8(11), e025694.

George, C., Matsha, T. E., Erasmus, R. T., & Kengne, A. P. J. B. o. (2018b). Haematological profile of chronic kidney disease in a mixed-ancestry South African population: a cross-sectional study. 8(11), e025694.

Gouva, C., Papavasiliou, E., Katopodis, K., Tambaki, A., Christidis, D., Tselepis, A., & Siamopoulos, K. J. N. d. t. (2006). Effect of Erythropoietin on Serum paf-acetylhydrolase in patients with Chronic Renal Failure. 21(5), 1270-1277.

Habib, A., Ahmad, R., & Rehman, S. J. I. J. R. M. S. (2017). Hematological changes in patients of chronic renal failure and the effect of hemodialysis on these parameters. 5(11), 4998-5003.

HADIAN, B., ANBARI, K., & HEIDARI, R. (2014). Epidemiologic study of end stage renal disease and related risk factors in patients under hemodialysis in Lorestan province.

Hsu, C.-Y., Bates, D. W., Kuperman, G. J., & Curhan, G. C. J. K. i. (2001). Relationship between hematocrit and renal function in men and women. 59(2), 725-731.

Hung, K., Lee, K., Yen, C., Wu, K., Tsai, T., Chen, W. J. N., dialysis, transplantation: official publication of the European Dialysis, & Association, T. A.-E. R. (1997). Revised cutoff values of serum aminotransferase in detecting viral hepatitis among CAPD patients: experience from Taiwan, an endemic area for hepatitis B. 12(1), 180-183.

Imran, S., Sheikh, A., Saeed, Z., Khan, S. A., Malik, A. O., Patel, J., . . . Hussain, A. J. J. P. M. A. (2015). Burden of chronic kidney disease in an urban city of Pakistan, a cross-sectional study. 65(4), 366-369.

Jafar, T. H., Schmid, C. H., & Levey, A. S. J. J. o. t. A. S. o. N. (2005). Serum creatinine as marker of kidney function in South Asians: a study of reduced GFR in adults in Pakistan. 16(5), 1413.

Jessani, S., Bux, R., & Jafar, T. H. J. B. n. (2014). Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan-a community based cross-sectional study. 15, 1-9.

Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., . . . Yang, C.-W. J. T. L. (2013). Chronic kidney disease: global dimension and perspectives. 382(9888), 260-272.

Katz, I. J. A. i. c. k. d. (2005). Kidney and kidney related chronic diseases in South Africa and chronic disease intervention program experiences. 12(1), 14-21.

Kheradmand, M., Moosazadeh, M., Saeedi, M., Poustchi, H., Eghtesad, S., Esmaeili, R., . . . Rafiei, A. J. A. o. I. m. (2019). Tabari cohort profile and preliminary results in urban areas and mountainous regions of Mazandaran, Iran. 22(6), 279-285.

Levey, A. S., Coresh, J., Bolton, K., Culleton, B., Harvey, K. S., Ikizler, T. A., . . . Kusek, J. (2002a). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Diseases, 39(2 SUPPL. 1), i-ii+ S1-S266.

Levey, A. S., Coresh, J., Bolton, K., Culleton, B., Harvey, K. S., Ikizler, T. A., . . . Kusek, J. J. A. J. o. K. D. (2002b). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. 39(2 SUPPL. 1), i-ii+ S1-S266.

Locatelli, F., Pozzoni, P., Vecchio, L. D. J. T., & management, c. r. (2007). Recombinant human epoetin beta in the treatment of renal anemia. 3(3), 433-439.

Lopes, E. P., Sette, L. H. B., Sette, J. B. C., Luna, C. F., Andrade, A. M., Moraes, M., . . . Conceição, S. C. J. C. (2009). Serum alanine aminotransferase levels, hematocrit rate and body weight correlations before and after hemodialysis session. 64, 941-945.

Lu, Y.-A., Fan, P.-C., Lee, C.-C., Wu, V. C.-C., Tian, Y.-C., Yang, C.-W., . . . Chang, C.-H. (2017). Red cell distribution width associated with adverse cardiovascular outcomes in patients with chronic kidney disease. BMC nephrology, 18(1), 1-7.

Maia, L. P. V., Martins‐Filho, O. A., Teixeira‐Carvalho, A., Speziali, E., Vermhren, R., Lira, E. F., . . . Malheiro, A. (2009). Hepatitis C virus screening and clinical monitoring of biomarkers in patients undergoing hemodialysis. Journal of medical virology, 81(7), 1220-1231.

Martins, D., Tareen, N., Zadshir, A., Pan, D., Vargas, R., Nissenson, A., & Norris, K. J. A. j. o. k. d. (2006). The association of poverty with the prevalence of albuminuria: data from the Third National Health and Nutrition Examination Survey (NHANES III). 47(6), 965-971.

McClellan, W., Aronoff, S. L., Bolton, W. K., Hood, S., Lorber, D. L., Tang, K. L., . . . opinion. (2004). The prevalence of anemia in patients with chronic kidney disease. 20(9), 1501-1510.

Mills, K. T., Xu, Y., Zhang, W., Bundy, J. D., Chen, C.-S., Kelly, T. N., . . . He, J. J. K. i. (2015). A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. 88(5), 950-957.

Moosazadeh, M., Espahbodi, F., Afshari, M., & Eslami, A. (2023). Can CBC profile and liver function test predict chronic kidney disease among a normal population? International Journal of Preventive Medicine, 14.

Mustafa, L. A., Al-Abachi, S. Z., & Khalaf, D. S. J. I. N. J. o. C. (2008). Some biochemical changes in serum of hemodialysis patients. 8(32), 695-700.

Nahas, M. E. (2005). The global challenge of chronic kidney disease. Kidney international, 68(6), 2918-2929.

Okyay, G. U., İnal, S., Öneç, K., Er, R. E., Paşaoğlu, Ö., Paşaoğlu, H., . . . Erten, Y. J. R. f. (2013). Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. 35(1), 29-36.

Ono, K., Ono, T., & Matsumata, T. (1995a). The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: the role of vitamin B6 deficiency. Clinical nephrology, 43(6), 405-408.

Ono, K., Ono, T., & Matsumata, T. J. C. n. (1995b). The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: the role of vitamin B6 deficiency. 43(6), 405-408.

Pizzorno, J. (2015). The kidney dysfunction epidemic, part 1: causes. Integrative Medicine: A Clinician's Journal, 14(6), 8.

Prasad, N., Barai, S., Gambhir, S., Parasar, D., Ora, M., Gupta, A., & Sharma, R. J. I. j. o. n. (2012). Comparison of glomerular filtration rate estimated by plasma clearance method with modification of diet in renal disease prediction equation and Gates method. 22(2), 103.

Rej, R., Fasce Jr, C. F., & Vanderlinde, R. E. J. C. C. (1973). Increased aspartate aminotransferase activity of serum after in vitro supplementation with pyridoxal phosphate. 19(1), 92-98.

Sette, L. H. B. C., & de Almeida Lopes, E. P. J. C. (2014). Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review. 69, 271-278.

Suresh, M., Mallikarjuna, R., Sharan, B., Singh, M., Hari Krishna, B., & Shravya, K. J. I. J. S. R. P. (2012). Hematological changes in chronic renal failure. 2(9), 1-4.

Tbahriti, H. F., Meknassi, D., Moussaoui, R., Messaoudi, A., Zemour, L., Kaddous, A., . . . Mekki, K. J. W. j. o. n. (2013). Inflammatory status in chronic renal failure: The role of homocysteinemia and pro-inflammatory cytokines. 2(2), 31.

Trevizoli, J. E., de Paula Menezes, R., Velasco, L. F. R., Amorim, R., de Carvalho, M. B., Mendes, L. S., . . . Neves, R. J. C. j. o. t. A. S. o. N. (2008). Hepatitis C is less aggressive in hemodialysis patients than in nonuremic patients. 3(5), 1385-1390.

Turkmen, K., Guney, I., Yerlikaya, F. H., & Tonbul, H. Z. J. R. f. (2012). The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. 34(2), 155-159.

Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The lancet, 389(10075), 1238-1252.

Wolf, P. L., Williams, D., Coplon, N., & Coulson, A. S. J. C. c. (1972). Low aspartate transaminase activity in serum of patients undergoing chronic hemodialysis. 18(6), 567-568.

Yassein, R. B., Alseedig, N. O., Abdallah, S. K., Mohammed, A., Alballah, N. A., & Syid, M. A. J. I. J. R. G. (2016). Hematological parameters among Sudanese patients with chronic renal failure. 4(16), 50-54.

Yasuda, K., Okuda, K., Endo, N., Ishiwatari, Y., Ikeda, R., Hayashi, H., . . . Irie, Y. J. G. (1995). Hypoaminotransferasemia in patients undergoing long-term hemodialysis: clinical and biochemical appraisal. 109(4), 1295-1300.

Yuki, N., Ishida, H., Inoue, T., Tabata, T., Matsushita, Y., Kishimoto, H., . . . Hayashi, N. J. J. o. c. g. (2000). Reappraisal of biochemical hepatitis C activity in hemodialysis patients. 30(2), 187-194.

Zhang, M., Zhang, Y., Li, C., & He, L. (2015). Association between red blood cell distribution and renal function in patients with untreated type 2 diabetes mellitus. Renal failure, 37(4), 659-663.