Non-Alcoholic Fatty Liver Disease Common in Chronic Kidney Disease Patients

Maha Abdelmoneim Behairy, MD, PhD

Patients being treated for chronic kidney disease (CKD) had a high frequency of non-alcoholic fatty liver disease (NAFLD), according to a paper published in Nephrology.

Investigators from Egypt conducted a cross-sectional study including 80 patients with non-diabetic CKD in order to evaluate the frequency of NAFLD in these types of patients. Of that cohort, the study authors noted, 50 patients were on hemodialysis and 30 patients were not but were in CKD stages G3-5. The patients were selected randomly from Ain Shams University Hospital in Cairo and were excluded if they had diabetes, obesity, alcohol intake, viral hepatitis, or drug-induced liver steatosis. As other studies have noted, between 40-80% of individuals with diabetes and between 30-90% of individuals who are obese are thought to have NAFLD.

The investigators used controlled attenuation parameter (CAP) (dB/m) of liver steatosis (S0–S3) and liver stiffness/fibrosis measurement (F0–F4), they said, using transient elastography called Fibroscan. They also evaluated the patients’ complete blood count, routine blood chemistry, and C-reactive protein (CRP) titer.

Just over half of the patients (56%) were found to have NAFLD. Of the 30 males and 15 females with NAFLD, there were 29 patients with end-stage renal disease who were on regular hemodialysis and an additional 16 patients with pre-dialysis CKD G3-5.

The researchers concluded that the mean CAP values of hepatic steatosis in the patients with CKD on dialysis and the patients with pre-dialysis CKD were 265 and 259, respectively. In addition, there was a significant association between the severity of hepatic steatosis degree with decreased glomerular filtration rate, as well as with increased CKD stage.

The degree of liver stiffness was significantly related to an increased hepatis steatosis grade. There was a significant positive correlation between the degree of NAFLD and serum levels of alanine aminotransferase, aspartate transaminase, total cholesterol, triglycerides, low-density lipoprotein, and CRP titer.

NAFLD was significantly associated with a history of cardiovascular disease among the study group.

“A high frequency of NAFLD was observed among the patients with non-diabetic CKD on hemodialysis and patients with pre-dialysis CKD,” the study authors concluded. “NAFLD may be associated with an increased liver stiffness grade and cardiovascular disease among those patients.”

In January, HCP Live reported on a new way for identifying patients at high risk for developing NAFLD. A study from the University of Wisconsin School of Medicine and Public Health recruited patients to undergo biopsy to prove NAFLD and found 87 patients had nonalcoholic steatohepatitis (NASH) and 112 had moderate to severe steatosis. Another 51 patients were found to have fibrosis stage F0, with 42 patients at stage F2, 37 patients at F3, and 33 patients at F4.

The patients in stages F3 and F4 were considered to be high risk for NAFLD, those study authors said. While the presence of NASH does not show up on a CT scan, CT scans can be used to identify patients with high-risk NAFLD, they wrote.

There are not currently any U.S. Food and Drug Administration-approved medicines for the treatment of NAFLD.