Research ArticleOriginal Article
Open Access

The association of liver fibrosis and chronic kidney disease in patients with metabolic associated fatty liver disease

A cross-sectional study

Rehab Badawi, Naglaa Samy Fahmy Abou Taira, Sara Essam Hasby, Walaa Elkhalawany, Waleed Elrefaey, Nahla Ahmed Khalf and Hanaa Ibrahim Okda
Saudi Medical Journal October 2024, 45 (10) 1034-1040; DOI: https://doi.org/10.15537/smj.2024.45.10.20240393

Article Figures & Data

Tables

  • Table 1

    - Comparison between non-chronic kidney disease and chronic kidney disease groups regarding demographic data and comorbidities.

    VariablesMAFLD patientsP-values
    Non-CKD group (n=80)CKD group (n=84)
    Age (years), mean±SD46.4±11.553.9±9.7<0.001*
    Gender
    Female48 (60.0)56 (66.7)0.376
    Male32 (40.0)28 (33.3)
    BMI (kg/m2), mean±SD37.5±6.936.0±7.30.179
    Comorbidities
    No28 (35.0)0 (0.0)<0.001*
    DM32 (40.0)12 (14.3)
    Hypertension12 (15.0)28 (33.3)
    DM and hypertension8 (10.0)40 (47.6)
    CVD0 (0.0)4 (4.8)

    Values are presented as numbers and percentages (%).

    MAFLD: metabolic associated fatty liver disease, CKD: chronic kidney disease, SD: standard deviation, BMI: body mass index, DM: diabetes mellitus, CVD: cardiovascular disease

    • ↵* Significant at a p-value of <0.05.

  • Table 2

    - Laboratory characteristics of the studied non-chronic kidney disease and chronic kidney disease groups.

    ParametersMAFLD patientsP-values
    Non-CKD group (n=80)CKD group (n=84)
    Serum uric acid(mg\dl)5.1±0.87.0±1.3<0.001*
    Triglycerides(mg\dl)131.3±52.0172.7±26.7<0.001*
    Cholesterol(mg\dl)212.8±38.8230.5±46.50.009*
    Serum albumin(g/dl)4.0±0.33.5±0.5<0.001*
    Bilirubin(mg\dl)1.0±0.11.0±0.20.142
    ALT (U\L)49.5±12.027.1±11.8<0.001*
    AST (U\L)45.0±8.730.2±15.2<0.001*
    Viral hepatitis markers
    Negative76 (95.0)52 (61.9)<0.001*
    HCV positive4 (5.0)12 (14.3)
    HCV positive not received treatment0 (0.0)8 (9.5)
    HCV positive received treatment0 (0.0)12 (14.3)

    Values are presented as mean ± standard deviation (SD) or numbers and percentages (%).

    MAFLD: metabolic associated fatty liver disease, CKD: chronic kidney disease, ALT: alanine transaminase, AST: aspartate aminotransferase, HCV: hepatitis C

    • ↵* Significant at a p-value of <0.05.

  • Table 3

    - Comparison of the steatosis and fibrosis status of the liver between the studied non-chronic kidney disease and chronic kidney disease groups.

    VariablesMAFLD patientsP-values
    Non-CKD group (n=80)CKD group (n=84)
    Steatosis score (dB\m), mean±SD257.3±46.8341.3 ±49.1<0.001*
    Steatosis degrees
    S00 (0.0)8 (9.5)<0.001*
    S18 (10.0)28 (33.3)
    S24 (5.0)32 (38.1)
    S368 (85.0)16 (19.0)
    Fibrosis score (kpa), median (IQR)9.2 (7.3-11.0), mean rank: 85.607.4 (6.0-14.4), mean rank: 79.550.414
    Fibrosis grades
    F016 (20.0)24 (28.6)<0.001*
    F14 (5.0)12 (14.3)
    F228 (35.0)12 (14.3)
    F328 (35.0)8 (9.5)
    F44 (5.0)28 (33.3)

    Values are presented as numbers and percentages (%).

    MAFLD: metabolic associated fatty liver disease, CKD: chronic kidney disease, SD: standard deviation, IQR: interquartile range

    • ↵* Significant at a p-value of <0.05.

  • Table 4

    - Associations between chronic kidney disease stages and the steatosis and fibrosis grades.

    VariablesCKD stagesP-values
    Stage 1Stage 2Stage 3Stage 4Stage 5
    Steatosis degrees
    S00 (0.0)0 (0.0)8 (40.0)0 (0.0)0 (0.0)<0.001*
    S14 (50.0)12 (50.0)0 (0.0)12 (42.9)0 (0.0)
    S24 (50.0)12 (50.0)4 (20.0)8 (28.6)4 (100)
    S30 (0.0)0 (0.0)8 (40.0)8 (28.6)0 (0.0)
    Fibrosis grades
    F08 (100)4 (16.7)4 (20.0)4 (14.3)4 (100)<0.001*
    F10 (0.0)4 (16.7)4 (20.0)4 (14.3)0 (0.0)
    F20 (0.0)8 (33.3)0 (0.0)4 (14.3)0 (0.0)
    F30 (0.0)0 (0.0)8 (40.0)0 (0.0)0 (0.0)
    F40 (0.0)8 (33.3)4 (20.0)16 (57.1)0 (0.0)

    Values are presented as numbers and percentages (%). CKD: chronic kidney disease

    • Table 5

      - Age, body mass index, and laboratory parameters of fibrosis and non-fibrosis groups (N=164).

      ParametersFibrosisP-values
      No (n=40)Yes (n=124)
      Age, years45.6±12.551.7±10.40.002*
      body mass index34.3±4.337.6±7.70.001*
      Fasting blood glucose (mg\dl), median (IQR)118.5 (0.0-130.0)113.0 (0.0-130.0)0.527
      Steatosis score (dB\m)287.8±43.0301.6±68.90.135
      Cholesterol (mg\dl)216.4±52.5223.6±40.50.363
      Triglycerides (mg\dl)155.6±34.3151.5±49.20.624
      Uric acid (mg\dl)6.0±1.36.1±1.50.537
      Creatinine (mg\dl), median (IQR)2.00 (1.0-7.03)1.10 (1.0-3.0)0.063
      Urea (mg\dl), median (IQR)61.8 (29.0-112.0)34.0 (23.0-111.0)0.581
      eGFR (ml/min/1.73m2)57.5±20.148.3±16.80.036*
      Serum albumin (g/dl)3.8±0.53.7±0.50.366
      Bilirubin (mg\dl)0.9±0.21.0±0.20.082
      ALT (U\L)29.9±14.840.7±16.0<0.001*
      AST(U\L)26.3±9.941.0±13.9<0.001*

      Values are presented as mean ± standard deviation (SD) or median and interquartile range (IQR).

      eGFR: estimated glomerular rate, ALT: alanine transaminase, AST: aspartate aminotransferase

      • ↵* Significant at a p-value of <0.05.

    • Table 6

      - Stepwise multivariable regression analysis model for prediction of fibrosis among cases with chronic kidney disease (N=84).

      PredictorsB coefficientP-valuesAOR95% CISensitivitySpecificityAccuracyP-values
      CKD stage 27.820.007*2494.53027.43-226846.4593.33%66.67%85.71%<0.001*
      CKD stage 33.150.036*23.481.22-451.93    
      Steatosis S2-5.880.002*0.0020.001-0.063    
      eGFR-0.1350.001*0.8730.802-0.951    

      AOR: adjusted odds ratio, CI: confidence interval, CKD: chronic kidney disease, eGFR: estimated glomerular rate

      • * Significant at a p-value of <0.05.

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