ABSTRACT FINAL ID: 1730
TITLE: The association between alanine aminotransferase and renal function in the Japan population: the Yamagata (Takahata) study.
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Background: It is well known that aminotransferase levels are lower in patients with chronic renal failure (CRF) undergoing dialysis compared with patients with normal renal function, but the association between alanine aminotransferase and renal function is not well known in patients with CRF without dialysis. In small-scale studies, some studies showed that serum aminotransferase levels are lower in patients with CRF without dialysis compared with patients with normal renal function. However, large-scale study has not been performed. This cohort study examined whether serum ALT levels associate with estimated glomerular filtration rate (eGFR) in the Japanese community-based population. Methods: The study cohort was recruited from a community-based annual health check-up, in which all inhabitants over 40 years of age in Takahata town, located in the northern part of Japan, were invited to participate. From June 2004 through to November 2006, a total of 3,520 adults agreed to join the study and 3,496 subjects (mean age, 62 years; 1,565 males and 1,921 females) without loss of data were analyzed in this study. Multivariate logistic regression analysis was used to determine whether eGFR independently predicts serum levels of ALT. The eGFR was estimated using the abbreviated MDRD equation with a Japanese coefficient. Results: The average of serum ALT (U/L) and eGFR (mL/min/1.73m2) was 23.3±14.0 (SD) and 81.5±16.5 (SD), respectively. In simple regression analysis, serum eGFR showed a significant positive correlation with ALT (p=0.0079). In multiple linear regression analysis with the adjustment for possible confounders including age, gender, body mass index (BMI), blood pressure, lipid profiles, HbA1c, hemoglobin and uric acid, eGFR was positively and independently associated with serum ALT (p<0.0001). In subgroup analysis, the association between eGFR and serum ALT was especially stronger in females (p<0.0001), subjects with eGFR<90 mL/min/1.73m2 (p=0.008), aged <65 (p=0.0004), and without obesity (p<0.0001) than the counterparts. Discussion: This study showed that eGFR is independently associated with serum ALT revels in the Japanese community-based population, and that this association was observed more strongly in females, nonelderly, non-obese population and subjects with eGFR <90. It is speculated that the reduction in aminotransferase activity in patients with CRF is partially due to the reduction in pyridoxal-5′-phosphate, a coenzyme of transaminases, and the presence of UV-absorbing materials. This study suggests that serum ALT levels might be underestimated in subjects with reduced renal function.