Identifying non-alcoholic fatty liver disease at risk for progression to chronic kidney disease

Post by Master, Doctor Mai Vien Phuong - Head of Department of Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

Nonalcoholic fatty liver disease covers a spectrum of chronic liver diseases, from steatosis on one end to fibrosis and cirrhosis on the other. Nonalcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH) are liver manifestations of the metabolic syndrome (MetS) and a driver of a multitude of comorbidities, such as insulin resistance, heart disease, and heart disease. cardiovascular disease (CVD), chronic kidney disease... there is increasing evidence that nonalcoholic fatty liver disease is a risk factor for chronic kidney disease due to shared metabolic risk factors.

Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of developing chronic kidney disease (CKD) than the general population. The prevalence of comorbidities along with the pathogenic mechanisms that directly link NAFLD to the development of chronic kidney disease may explain this finding. Given the breadth of data linking nonalcoholic fatty liver disease to chronic kidney disease, there are few options for treatment in this group of patients. Regardless, we have presented strategies that can be implemented at various levels including monitoring, prevention and management levels. Role of the noninvasive fibrosis scoring system: The noninvasive scoring system is used to assess the severity of various chronic liver diseases. However, they have also been shown in several studies to be useful in predicting chronic kidney disease in patients with nonalcoholic fatty liver disease.
Gradual increase in fatty liver index was an independent risk factor for the development of chronic kidney disease in a 10-year prospective analysis of 6238 adults (40-69 years) without chronic kidney disease at initial time. In another study of 11376 Taiwanese subjects, NFS was negatively correlated with eGFR. Many studies show that patients with an intermediate and high-risk type of fibroid-4 index (FIB-4)-Index and NFS are at increased risk of renal failure, while a cross-sectional study in 2019 of 11836 patients showed that FIB-4 is the most accurate tool when estimating renal dysfunction due to non-alcoholic fatty liver disease (area under the curve = 0.6227, 95% CI: 0. 5929-0.6526, P = 0.0258) after adjusting for different demographic and clinical variables [81]. FIB-4 was also the most dominant predictor in other studies.
In summary, patients with fibrosis associated with nonalcoholic fatty liver disease are at increased risk for chronic kidney disease and these patients should be appropriately monitored through a noninvasive fibrosis scoring system. encroachment or advanced imaging techniques (ie Fibroscan, TE)

Identify and manage patients with nonalcoholic fatty liver disease at risk of developing chronic kidney disease. Nonalcoholic fatty liver disease, chronic kidney disease, chronic kidney disease, HTN, hypertension, WHR: Waist-to-Hip Ratio, GGT: Gamma-glutamyl transferase; Type 2 diabetes: Type 2 diabetes, SLKT: Concurrent liver-kidney transplant; SGLT2: Type-2 sodium-glucose cotransporter; GLP-1: Peptide 1 like glucagon. Serum creatinine, a widely used biomarker in the assessment of renal function, is not accurate in determining GFR in patients with cirrhosis. This is due to the muscle wasting that occurs in cirrhosis, which in turn leads to decreased creatinine formation, increased tubular creatinine secretion, and impaired laboratory interpretation due to increased bilirubin. In addition, measurement of cystatin C does not have the same limitations as serum creatinine due to its low molecular weight and because it does not require adjustment for sex, mass, or bilirubin levels. The combination of serum creatinine and cystatin C is more accurate in determining GFR than serum creatinine alone. However, serum creatinine alone was higher for patients without cirrhosis. Measurement of cystatin C along with serum creatinine may be useful to accurately assess renal function in organ transplant recipients and to monitor the development of chronic kidney disease in patients with cirrhosis and nonalcoholic steatohepatitis. Although the cost of measuring eGFR using Cystatin C in addition to serum creatinine is higher, the undue diagnostic burden in patients with cirrhosis is reduced, which may lead to an overall reduction in unnecessary medical costs. essential for cirrhotic patients who actually have kidney failure.
Alkaline phosphatase and GGT in diabetic patients with NAFLD, serum alkaline phosphatase (ALP), a marker associated with NAFLD when elevated, is also associated significantly associated with impaired renal function. Interestingly, ALP is associated with the release of proinflammatory cytokines from the liver that are known to disrupt glomerular endothelial glycocalyx, leading to albuminuria, which may explain why ALP is a surveillance marker potential in nonalcoholic fatty liver disease patients at risk of developing chronic kidney disease. Furthermore, elevated serum GGT is associated with an increased risk of chronic kidney disease. GGT is associated with increased markers of inflammation and insulin resistance, both of which play a central role in nonalcoholic fatty liver disease patients who develop chronic kidney disease. However, elevated GGT may not be an accurate chronic kidney disease parameter in Caucasian men, as GGT is influenced by BMI, lifestyle factors, and lipids, as noted in one study 2017. Therefore, elevated GGT in Caucasian men with nonalcoholic fatty liver disease should be interpreted with caution when monitoring chronic kidney disease. Importantly, non-alcoholic fatty liver disease was diagnosed by elevated GGT levels (apart from ultrasound in only one study; thus, these findings may not apply to patients diagnosed by more invasive parameters (ie liver biopsy).

Despite extensive research, minimal guideline management of patients with both nonalcoholic fatty liver disease and chronic kidney disease is available. However, the important pathogenic associations and common risk factors between nonalcoholic fatty liver disease and chronic kidney disease emphasize the importance of earlier surveillance and strict control of risk factors. general metabolic risk. Although strategies for the prevention of chronic kidney disease in nonalcoholic fatty liver disease are limited, future guided treatment specifically for nonalcoholic steatohepatitis is expected to improve progression. of renal dysfunction in affected patients.