Abstract
Metabolic syndrome, an etiological factor in non-alcoholic fatty liver disease (NAFLD), is often present in hemodialysis patients. Little is known about the prevalence of, and factors associated with, liver fibrosis in hemodialysis populations. We used transient elastography (TE) to investigate these phenomena. 659 patients treated with chronic hemodialysis were enrolled. We excluded those with excess alcohol intake, liver stiffness measurement (LSM) failure, or unreliable LSM values. LSM ≥8.0 kPa was used as a cutoff suggesting clinically relevant fibrosis. Controlled attenuation parameter (CAP) ≥ 232.5 dB/m was used as a cutoff suggesting steatosis. 333 patients (50.5%) had steatosis, 159 (24.1%) had hepatitis B or C, and 149 (22.6%) had LSM ≥8.0 kPa. In multivariable analyses, male gender (OR: 2.16; 95% CI: 1.29–3.63; P = 0.004), overweight body habitus (OR:2.31; 95% CI: 1.35–3.94; P = 0.002), high AST level (OR:1.08; 95% CI: 1.04–1.12; P < 0.001), low albumin level (OR: 0.25; 95% CI: 0.12–0.53; P < 0.001), low creatinine level (OR: 0.89; 95% CI: 0.79–1.00; P = 0.05) and low platelet count (OR: 0.99; 95% CI: 0.99–1.00; P < 0.001) were associated with LSM ≥8.0 kPa. We thus conclude that hemodialysis patients have a high prevalence of NAFLD and clinically relevant fibrosis. NAFLD may be an important determinant of clinically relevant fibrosis in hemodialysis populations.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, affecting 15–40% of the population worldwide[1]
Multivariate analyses showed that male gender (odds ratio [OR]: 2.16, 95% confidence interval [CI]: (1.29–3.63), P = 0.004), overweight body habitus (i.e., 24 ≤ body mass index (BMI) < 30 (OR: 2.31, 95% CI: 1.35–3.94, P = 0.002)), high AST level (OR: 1.08, 95% CI: 1.04–1.12, P < 0.001), low albumin level (OR: 0.25, 95% CI: 0.12–0.53, P < 0.001), low creatinine level (OR: 0.89. 95% CI: 0.79–1.00, P = 0.05) and low platelet count (OR: 0.99. 95% CI: 0.99–1.00, P < 0.001) were independent factors associated with liver stiffness measurement (LSM) ≥8.0 kPa (Table 2)
Multivariate analyses showed that male gender (OR: 2.75, 95% CI: 1.16–6.52, P = 0.02), obesity (i.e., BMI ≥30 (OR: 13.64, 95% CI: 2.06–90.50, P = 0.007)), high AST level (OR: Characteristic Age, years Female BMI Normal; BMI
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, affecting 15–40% of the population worldwide[1]. Transient elastrography (TE) is a non-invasive test of liver fibrosis that is quick and easy to perform and causes no discomfort. It has high accuracy and reproducibility when used to detect advanced fibrosis and cirrhosis. CAP measurements have been shown to be accurate in estimating the amount of liver fat[9,10,11] It is possible, using the non-invasive technique of TE, to measure liver fat and fibrosis simultaneously. Only a limited number of studies have been performed focusing on the prevalence and risk factors for liver fibrosis in ESRD patients. Associated with, clinically relevant liver fibrosis, as measured by TE, in a large cohort of ESRD patients on maintained hemodialysis
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