Transient elastography as a screening tool for liver fibrosis in a large hemodialysis population

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.

Which factors influence liver stiffness measured by real-time two dimensional shear wave elastography in patients on maintenance hemodialysis?

“…According to Cheng et al ( 28 ), lower PLT count was correlated with higher LS values. A possible explanation could be that PLT are regulated by thrombopoietin, which is produced by hepatocytes and the kidney.…”

“…LS values are elevated in healthy people with BMI>30 kg/m 2 , and in patients with viral hepatitis, primary biliary cholangitis, alcoholic liver disease, and cholestatic liver diseases independent of the degree of fibrosis ( 20 - 23 ). LS correlates significantly with portal pressure and arterial pressure ( 24 - 27 ), and is affected by volume overload: either due to heart failure or liver failure with ascites ( 11 , 28 ). To avoid volume overload, LS measurement should be performed following a hemodialysis (HD) session ( 29 - 31 ).…”

“…To the best of our knowledge, most such studies have been conducted on patients with underlying liver disease ( 32 , 33 ). Only a few have focused on factors that influence LS (measured by transient elastography) and fibrosis in HD population ( 28 ). In dialysis patients, active chronic inflammation possibly affects the liver and changes LS ( 34 ).…”

Mortality and Kidney Transplantation Outcomes Among Hepatitis C Virus–Seropositive Maintenance Dialysis Patients: A Retrospective Cohort Study

“…When sufficient laboratory data were available, we calculated the Fibrosis-4 (FIB-4) index, which is highly associated with severity of liver fibrosis (Item S1). [38][39][40] We also fit models that accounted for patient acceptance of HCV-seropositive organs.…”

Evaluating CKD/ESRD patient with hepatitis C infection: How to interpret diagnostic testing and assess liver injury

“…A recent study used TE as a screening tool to evaluate chronic liver disease in a HD cohort of patients showing presence of clinical significant fibrosis (stiffness ≥8 kPa) in 22.6% of patients overall. NAFLD, defined as CAP ≥232.5 dB/m, was present in 50.5% of HD patients …”