Prevalence and Correlates of Hepatic Steatosis and Fibrosis in Patients with CKD before Kidney Transplantation: A Retrospective Cohort Study

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Background: Metabolic dysfunction associated steatotic liver disease (MASLD), is closely linked to CKD and increases the risk of hepatic fibrosis and cardiovascular damage. MASLD is common in the general population but data on dialysis patients is limited. We aim to assess the prevalence of MASLD and related factors in kidney transplant patients at the time of list admission. Methods: We studied 531 kidney transplant patients (age 49±13, 59% male) from 2010-2020. We noted their data at admission. Hepatic steatosis (HS) was gauged by hepatic steatosis index (HSI), with >36 as pathological (HSI+). Advanced fibrosis (>F3) was assessed by Fibrosis-4 index (FIB4), with >1.3 and >2.66 as borderline and pathological (FIB4+), and the NAFLD Fibrosis Score (NFS), with >-1.455 and >0.676 as borderline and pathological (NFS+). Results: In our study, 67.2% of patients had hemodialysis. At evaluation, 8.8% had diabetes, 15% were obese, and 37.5% had steroid treatment history. Glomerulonephritis and polycystic kidney disease caused nephropathy in 20% and 18% of cases, respectively. HSI, FIB4, and NFS averages were 32.9±6.01, 1.25±1.07, and -1.75±1.5. FIB-4 and NFS correlated strongly (r=0.65, p<0.0001). HS by HSI+ was in 27.5% of patients, while hepatic fibrosis by FIB4+ and NFS+ was in 32.8% and 39.3% of patients. HSI+ patients were older with higher BMI, glucose, and urea levels. FIB4+ and NFS+ patients were older with higher glucose and CRP levels. NFS+ patients had higher BMI. These results confirm the concordance between the two fibrosis markers. In multivariate analysis, BMI and urea were independent risk factors for hepatic steatosis by HSI, while age and CRP were independent risk factors for hepatic fibrosis by both FIB4+ and NFS+. Conclusion: Our data reveals a high occurrence of MASLD in patients awaiting kidney transplants, particularly in older, overweight individuals. Inflammatory parameters independently predicted hepatic fibrosis, suggesting their potential role. FIB4 and NFS showed a strong correlation, validating their use as fibrosis markers. Future research could shed light on the causes, risk factors, and impacts of HS and fibrosis on kidney transplant outcomes.

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