Liver Steatosis: Better Predictor of CKD in MAFLD Than Liver Fibrosis as Determined by Transient Elastography With Controlled Attenuation Parameter.

Luciana Marc,Vlad Tucicovschi,Iulia Grosu,Flaviu Bob,Lazar Chisavu,Bogdan Timar,Florica Gadalean,Nicu Olariu,Adelina Mihaescu,Adalbert Schiller,Ioan Sporea,Romulus Timar,Raluca Lupusoru

doi:10.3389/fmed.2021.788881

Abstract

Background: Changing the term/concept of the non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction associated fatty liver disease (MAFLD) may broaden the pathological definition that can include chronic renal involvement, and, possibly, changes chronic kidney disease's (CKD's) epidemiological association with liver disease, because CKD is associated with metabolic disorders and almost all patients with CKD present some form of an atherogenic dyslipidemia. Our study explores the relationship between MAFLD and CKD using Transient Elastography (TE) with a Controlled Attenuated Parameter (CAP).Methods: We evaluated 335 patients with diabetes with MAFLD and with high CKD risk using TE with CAP (FibroScan®). The CKD was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Logistic regression and stepwise multiple logistic regression were used to evaluate the factors associated with CKD. In addition, a receiver operating characteristic curve (ROC) analysis was used to assess the performance of CAP and TE in predicting CKD and its optimal threshold.Results: The prevalence of CKD in our group was 60.8%. Patients with CKD had higher mean liver stiffness measurements (LSM) and CAP values than those without CKD. We found that hepatic steatosis was a better predictor of CKD than fibrosis. Univariate regression showed that CAP values >353 dB/m were predictive of CKD; while the multivariate regression analysis (after adjustment according to sex, body mass index (BMI), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc), and fasting glucose) showed that CAP values >353 dB/m were more strongly associated with the presence of CKD compared to the LSM (fibrosis) values.Conclusion: In patients with MAFLD, CAP-assessed steatosis appears to be a better predictor of CKD compared to LSM-assessed hepatic fibrosis.

Highlights

Recent data have proven that fatty liver, associated liver inflammation, and fibrosis [non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)] increase the risk of chronic kidney disease (CKD) [1]
Another studies by Ciardullo et al [12, 13], Lomonaco et al [14], and Yeung et al [15] sustained the same, that in patients with NAFLD, liver fibrosis is associated with CKD and their prevalence of liver steatosis and liver fibrosis is greater in our study, but it may be due to the differences between the study cohorts
Our study investigated patients with established metabolic dysfunction associated fatty liver disease (MAFLD) and its association with CKD

Summary

Introduction

Recent data have proven that fatty liver, associated liver inflammation, and fibrosis [NAFLD and non-alcoholic steatohepatitis (NASH)] increase the risk of chronic kidney disease (CKD) [1]. Our paper aimed to explore this relation using liver steatosis and liver fibrosis assessments by transient elastography (TE) with controlled attenuation parameter (CAP). Changing the term/concept of the non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction associated fatty liver disease (MAFLD) may broaden the pathological definition that can include chronic renal involvement, and, possibly, changes chronic kidney disease’s (CKD’s) epidemiological association with liver disease, because CKD is associated with metabolic disorders and almost all patients with CKD present some form of an atherogenic dyslipidemia. Our study explores the relationship between MAFLD and CKD using Transient Elastography (TE) with a Controlled Attenuated Parameter (CAP)

Methods

Results

Discussion

Conclusion