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

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

“Multimorbidity is increasing, and it is essential to understand the clinical consequences of having more than one medical condition”, There is a hyde, MBBS, B.Sc., PhD, The NIHR clinical lecturer in hepatology at the University of Liverpool, told Healio. “Bold liver disease, in particular, is independently associated with several non-hepatic conditions, including heart disease and chronic kidney disease.

Seeking 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 at the help from the UK Biobank. Participants provided information related to medical history, demographics, and lifestyle factors, which was supplemented by an electronic link to hospital records and death records.

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

At baseline, 54.5% of CKD patients had NAFLD, with signs 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 was correlated with an 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 univariate analysis. After multivariate adjustment for demographics, metabolic factors, and baseline kidney function, NAFLD was not associated with increased risk for the 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 elevated 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 was correlated with an increased incidence of CV events (HR=1.39; 95% CI, 1.06-1.82), including heart failure (HR=1.65 95% CI, 1.16-2.33).

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 findings underscore the importance of better recognition of fatty liver with fibrosis in people with chronic kidney disease to inform the need for vigorous control of cardiometabolic risk factors in this group,” Hydes said. “It also suggests the need to work to understand the mechanisms linking these conditions to help drive new drug discoveries.”

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International Liver Congress