Abstract
An association between liver stiffness, a surrogate measure of liver fibrosis, and chronic kidney disease (CKD) in patients with nonalcoholic fatty liver disease (NAFLD) has been proposed. However, most studies were small and had low statistical power. We systematically searched PubMed-MEDLINE and Scopus from inception to August 2021 for cross-sectional or cohort studies reporting the association between liver stiffness diagnosed by vibration controlled transient elastography (VCTE) and renal dysfunction. The primary outcome was CKD, defined as a composite of urinary albumin to creatinine ratio (UACR) ≥ 30 mg/g and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Measures of association from individual studies were meta-analyzed using random effects models. Of the 526 titles initially scrutinized, 7 cross-sectional studies fulfilled the criteria and were included. For CKD, risk was higher in patients with liver fibrosis assessed by VCTE, compared with patients without (n = 5 studies: OR 2.49, 95% CI 1.89–3.29; test for overall effect z = 6.475, p < 0.001). When increased UACR was considered as an outcome, elevated liver stiffness was associated with a significantly increased risk as well (n = 3 studies: OR 1. 98 95% CI 1.29–3.05; test for overall effect z = 3.113, p = 0.002). Neither analysis showed significant heterogeneity (I2 = 0% and I2 = 46.5%, respectively for the two outcomes). This meta-analysis indicates that elevated liver stiffness is associated with increased odds of kidney outcomes among patients with NAFLD. Wider use of VCTE to screen for advanced fibrosis might help identify patients at risk of end-stage renal disease.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is recognized as the most common chronic liver condition, affecting a quarter of the world adult population [1] and 37% of US adults [2]
We previously showed that significant liver fibrosis on vibration controlled transient elastography (VCTE) was independently associated with albuminuria and chronic kidney disease (CKD) in the general US population [14]
We systematically searched PubMed-MEDLINE and Scopus to identify articles reporting the results of observational studies published up to August 2021 investigating the association between liver stiffness and CKD
Summary
Nonalcoholic fatty liver disease (NAFLD) is recognized as the most common chronic liver condition, affecting a quarter of the world adult population [1] and 37% of US adults [2]. The vast majority of patients with NAFLD will not develop cirrhosis in their lifetime, due to the low overall risk and the competing risks of dying from cardiovascular disease (CVD) and extra-hepatic cancers, which remain the most common causes of death in this population [3,4]. Several studies have shown that NAFLD may impact liver-related prognosis, and act as an independent risk factor for a series of chronic conditions including CVD [8], chronic kidney disease (CKD) [9] and extra-hepatic cancers [10]. In a recent meta-analysis including studies identifying NAFLD patients using
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