Liver fibrosis linked to CV events, survival in NAFLD, chronic kidney disease


Hydes T, et al. Summary OS048. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).

Hydes does not report any relevant financial disclosures.

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LONDON — Elevated non-invasive markers of liver fibrosis correlated with an increased risk of cardiovascular events, end-stage renal disease, and poorer survival in patients with chronic kidney disease and non-alcoholic fatty liver disease.

“Multimorbidity is on the rise and it is vital to understand the clinical consequences of having more than one medical condition,” There is a HydesMBBS BScdoctorate, NIHR clinical lecturer in hepatology at the University of Liverpool, Healio told. “Fat” liver disease, in particular, has been independently associated with several non-liver diseases, including heart disease and chronic kidney disease.”

After a median follow-up of 10 years, NAFLD correlated with an increased risk of: “Variable A” – Cardiovascular events;  HR = 1.39 “Variable B” – All-cause mortality;  HR = 1.1

To assess the effect of NAFLD and NAFLD fibrosis on adverse clinical outcomes and mortality in patients with chronic kidney disease (CKD), Hydes and colleagues analyzed data from 26,074 patients using the UK Biobank. Participants provided information related to medical history, demographics and lifestyle factors, which was supplemented with hospital and death records via electronic links.

Researchers used Cox regression to estimate risk ratios associated with NAFLD and advanced liver fibrosis resume events, progression to end-stage renal disease (ESRD) and all-cause mortality.

At baseline, 54.5% of patients with CKD had NAFLD, with evidence of advanced fibrosis in 7% [NAFLD fibrosis score (NFS) 0.676]3.2% [elevated fibrosis-4 (FIB-4) > 2.67] and 1.1% [AST to platelet ratio index (APRI) 1]†

After a median follow-up of 10 years, NAFLD correlated with increased risk of CV events (HR = 1.39; 95% CI, 1.29-1.51) and all-cause mortality (HR = 1.1; 95 % CI, 1.01-1.19) but not ESRD (HR = 1.22; 95% CI, 0.95-1.56) in a univariate analysis. After multivariate adjustment for demographics, metabolic factors, and baseline renal function, NAFLD was not associated with an increased risk of primary outcomes.

Advanced liver fibrosis using all scores correlated with an increased risk of all-cause mortality (HR = 2.34-2.9), and NFS and FIB-4 associated with an increased risk of CV events (HR = 2.49; 95% CI, 2.11-2.93 and HR = 1.94; 95% CI, 1.53-2.45) and ESRD (HR = 6.85; 95% CI, 4.29-10.94 and HR = 2.35; 95% CI, 1.19-4.67). After full adjustment, FIB-4 correlated with an increased incidence of CV events (HR = 1.39; 95% CI, 1.06-1.82), especially heart failure (HR = 1.65; 95% CI, 1.16-2.33).

Both FIB-4 and APRI associated with all-cause mortality (HR = 1.55; 95% CI, 1.21-2 and HR = 2.83; 95% CI, 1.95-4.11) and NFS ( -1.455) associated with progression to ESRD (HR = 1.89; 95% CI, 1.13-3.17).

“These results highlight the importance of improved recognition of fatty liver with fibrosis in people with chronic kidney disease to inform the need for vigorous cardiometabolic risk factor control in this group,” Hydes said. “It also suggests the need for work to understand the mechanisms linking these conditions to drive new drug discovery.”

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