Metabolic Dysfunction-associated Steatotic Liver Disease Exacerbates Heart Failure Risk in Patients with Chronic Kidney Disease: A Nationwide Cohort Study

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Abstract Background Steatotic liver disease (SLD) and chronic kidney disease (CKD) are known risk factors for heart failure (HF). We aimed to investigate the risk of developing HF associated with SLD in patients with CKD. Methods Individuals aged ≥ 20 years who underwent health checkups in 2012 were analyzed using data from the National Health Insurance Services of South Korea. Patients with CKD and an estimated glomerular filtration rate < 60 mL/min/1.73m 2 or a previous diagnosis of end-stage renal disease were classified into the following categories for comparison of occurrence of HF: no steatosis, metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with other combined etiology, MASLD and increased alcohol intake, alcohol-associated liver disease, specific etiology SLD, cryptogenic SLD. Liver steatosis was defined as fatty liver index (FLI) ≥ 30. Results A total of 169,500 patients with CKD were analyzed, 42.4% were male, the mean age was 62.8 ± 12.6 years, and the mean body mass index was 24.4 ± 3.3 kg/m 2 . MASLD (hazard ratio [95% confidence interval]: 1.133 [1.106, 1.161]), MASLD with other combined etiology (1.276 [1.207, 1.350]), and cryptogenic SLD (1.817 [1.095, 3.015]) were associated with higher incidence of HF than those without steatosis. Additionally, an increment of FLI and cardiometabolic risk factors were associated with an increased risk of HF. Conclusions The incidence of HF was higher in patients with CKD who also had MASLD or cryptogenic SLD. An increase in the FLI and cardiometabolic risk factors in patients with CKD increases the risk of HF.

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