Nonalcoholic Fatty Liver Disease (NAFLD) and Sarcopenia in CKD Stages 1-5 Non-Dialysis Patients

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Background: NAFLD is a chronic liver disease characterized by excess fat accumulation in the liver. It is associated with metabolic syndrome and often has comorbidities such as obesity, diabetes, and dyslipidemia. NAFLD has been associated with various non-liver comorbidities, including cardiovascular disease, CKD, and sleep apnea, closely related to Sarcopenia. Sarcopenia, defined as low muscle mass and impaired muscle function, is associated with NAFLD and worse outcomes. This crossover study aims to assess the prevalence of Sarcopenia in CKD patients with NAFLD evaluated by bioelectrical impedance (BIA). Methods: 854 CKD pts, age 72,02(14,07),40.2% female, 41.2%, DM2, 48.4% obese men (%fat mass>25%) and 29% obese female (% fat mass >35%), GFR-EPI 51.6 (26.8) ml/min/1.73m2, UACR 258.36 (630), were enrolled. NAFLD was evaluated by BIA (Bioscan I8, Maltron, London) using the manufacturer software based on the fat/muscle ratio, staging NAFLD in 5 stages (0-4). Sarcopenia defined as EWGSOP2 (2018); cut-off points for dynapenia <27kg for men and <16kg for women of dominant arm muscle strength and muscle mass <20kg male and <15kg female. AGEs by autofluorescence were read by (DiagnOtics, Groningen, Netherlands)), and vascular Age was obtained from the Koetsier equation(AGEs0.83)/0.24. Data were processed with SPSS 27. A p-value <0.05 was considered statistically significant. Results: NAFLD incidence was 89.8%. 36.9% female and 63.1% men. Obese 86.4% and Diabetic 94%. Sarcopenia was identified in 6 men (1.23%) and 12 women (4.24%) p<0.001. Comparing NAFLD all stages vs Non-NAFLD: %Fat mass 35 (8.39) vs 27,58 (8.03)% (p<0.001); GFR-EPI 50.09(25.5) vs 66.14(32.09) (p<0.001). Vascular age-age : 16.7(25) vs 14.74(p<0.001). Stages incidence: Healthy 10.2%; Stage1 10.7%; Stage2 15.1%, Stage3 17.4% Stage 4(severe)46.6%. UACR 257.6 (629) vs 265 (638) (NS). Conclusions: NAFLD is highly frequent in CKD patients-associated obesity, DM2 and lower GFREPI. Unexpectedly, according to EWGSOP2 (2018) criteria, Sarcopenia is scant, more frequent in women. NAFLD related parameters were %fat Mass, DM2, obesity, GFR-EPI and average of vascular age, showing an inflammatory and premature aging status. BIA is a valuable tool, non observer dependent, non-invasive and easy to use. Funding: Other NIH Support - SERGAS. National Health Service Spain

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