Liver Stiffness, Albuminuria and Chronic Kidney Disease in Patients with NAFLD: A Systematic Review and Meta-Analysis

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.

Adverse Effects of Perfluorooctane Sulfonate on the Liver and Relevant Mechanisms

“…The effects on liver function, hepatocyte proliferation, liver tumors, liver immunity, and cholesterol and bile acid metabolism cannot be ignored. There is substantial evidence that impaired structure and function of liver tissues or cells can affect the function of other tissues and organs; for example, emerging changes in renal function in patients with acute or chronic liver disease often lead to acute kidney injury [ 161 ] or chronic kidney diseases [ 162 ]. Severe abnormalities in liver function can even damage the nervous system and cause central nervous system dysfunction, leading to the development of hepatic encephalopathy [ 163 ].…”

Increased Risk of NAFLD in Adults with Glomerular Hyperfiltration: An 8-Year Cohort Study Based on 147,162 Koreans

“…However, GHF and NAFLD share a common pathophysiology and similar phenotype. Thanks to previous studies, it is well known that the degree of liver fibrosis is strongly associated with albuminuria and CKD in patients with NAFLD [ 32 ]. Increased IR, which is a major causative factor of NAFLD [ 33 ], has also been associated with GHF [ 13 , 31 , 32 ].…”

“…Thanks to previous studies, it is well known that the degree of liver fibrosis is strongly associated with albuminuria and CKD in patients with NAFLD [ 32 ]. Increased IR, which is a major causative factor of NAFLD [ 33 ], has also been associated with GHF [ 13 , 31 , 32 ]. Obesity that induces IR promotes oxidative stress along with chronic inflammation, and dysregulation of adipokines, which are secreted from subcutaneous fat or visceral fat in obese patients and contribute to the development of ectopic fat accumulation in the liver, may be associated with renal hyperfiltration [ 34 ].…”

Non-Alcoholic Fatty Liver Disease and Risk of Macro- and Microvascular Complications in Patients with Type 2 Diabetes

“…Interestingly, accumulating observational studies using vibration controlled transient elastography (VCTE), as non-invasive method to evaluate the degree of liver fibrosis, also reported an independent association between liver stiffness and renal dysfunction. In this regard, for instance, in a 2022 systematic review and meta-analysis of seven cross-sectional studies for a total of 7736 individuals with NAFLD, Ciarduillo et al showed that liver fibrosis (as assessed by VCTE) was associated with an increased risk of prevalent CKD (defined as eGFR < 60 mL/min/1.73 m 2 and urinary albumin to creatinine ratio ≥30 mg/g) (randomeffects odds ratio 2.49, 95% confidence interval 1.89-3.29; I 2 = 46.5%), as well as with an increased risk of prevalent albuminuria (random-effects odds ratio 1.98, 95% confidence interval 1.29-3.05; I 2 = 46.5%) [32]. However, it should be noted that, at present, only few observational studies on this topic have used liver biopsy for the diagnosis of NAFLD, which is the reference standard for diagnosing and staging NAFLD [1,2].…”