Assessment of Thyroid Hormones and Liver Enzymes in Patients With Chronic Kidney Disease Undergoing Maintenance Hemodialysis in Al-Qaim General Hospital, Iraq

Chronic kidney disease (CKD) is associated with endocrine and metabolic disturbances that extend beyond classical renal biomarkers and may influence both thyroid homeostasis and liver-related biochemical indices. The present case-control study evaluated serum thyroid hormones and liver enzymes in 60 patients with CKD receiving maintenance hemodialysis at Al-Qaim General Hospital, Al-Anbar Governorate, Iraq, and compared them with 30 apparently healthy controls. Blood samples were obtained before the dialysis session. Serum thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were measured by standard immunoassay and colorimetric methods. CKD patients showed significantly higher mean levels of TSH, AST, ALT, and ALP and significantly lower mean levels of T3 and T4 than controls (P<0.001 for all comparisons). Within the patient group, TSH was significantly higher in females than males (P=0.032), whereas T3, T4, AST, ALT, and ALP did not differ significantly by sex. Patients younger than 50 years had significantly higher TSH and ALP values than older patients (P=0.010 and P=0.035, respectively). No significant differences were observed according to monthly dialysis frequency or disease duration. ROC analysis showed strong discriminatory performance within this dataset for AST (AUC=0.988), TSH (AUC=0.916), and ALT (AUC=0.871). These findings indicate that CKD patients on maintenance hemodialysis in Al-Qaim exhibit a distinct biochemical pattern characterized by altered thyroid function and increased liver enzyme activity, with additional variation related to sex and age in selected markers.