Modified Range of Alanine Aminotransferase is Insufficient for Screening of Hepatitis C Virus Infection in Hemodialysis Patients

OBJECTIVE: A moderate increase in serum alanine aminotransferase (ALT) has been reported to be a helpful, low-cost tool for predicting viremia in anti-hepatitis C virus (HCV)-positive hemodialysis (HD) patients. This study focused on evaluating the effectiveness of a lowered normal serum ALT value as a screening method for HCV infection in HD patients. MATERIAL AND METHODS: Serum ALT levels were compared with HCV virologic status in 125 patients on maintenance HD. RESULTS: The prevalence of HCV antibodies was 23%. A total of 3.7% of viremic HD patients did not have a detectable antibody response. Using the conventional upper limit of normal for ALT of 37 IU, there was no significant difference in the frequency of elevated ALT levels between HCV RNA-positive and-negative patients. However, if the upper limit of normal for ALT was lowered to 27 IU, the difference was significant. Nevertheless, 60% of viremic patients still fell within the normal range. CONCLUSION: Although inexpensive and widely available, the monitoring of serum ALT levels is not useful as a screening method for HCV infection in HD patients.