Metabolic dysfunction‐associated fatty liver disease (MAFLD) and advanced liver fibrosis among hemodialysis patients in a multiethnic urban population in Malaysia

Abstract

Background: Metabolic-dysfunction-associated fatty liver disease (MAFLD) and end stage kidney disease (ESKD) are complications of the metabolic syndrome. Our aim is to study the prevalence of MAFLD and advanced liver fibrosis and the associated factors among hemodialysis patients in a multiracial urban population in Malaysia. Methods:A cross-sectional study of hemodialysis patients from 10 hemodialysis centers was used. FibroTouch examination was performed on all patients. Fatty liver was diagnosed based on ultrasound attenuation parameter ≥248 dB/m while advanced liver fibrosis was diagnosed based on liver stiffness measurement ≥10 kPa.Results: This study included 447 hemodialysis patients (median age 59 [50-67], male 55%, Chinese 61%, Malay 20%, Indian 18%). Dialysis vintage was 49 (22-93) months.The prevalence of MAFLD was 43.4%. Independent factors associated with MAFLD were elevated waist circumference (aOR = 10.1, 95% CI = 5.3-19.4, p < 0.001), normal platelet count (aOR = 3.1, 95% CI = 1.3-7.3, p < 0.05), low HDL cholesterol (aOR = 2.3, 95% CI = 1.3-4.2, p < 0.01), elevated fasting blood sugar (aOR = 2.3, 95% CI = 1.3-3.8, p < 0.01), elevated hsCRP (aOR = 2.2, 95% CI = 1.2-4.0, p < 0.01), and advanced liver fibrosis (aOR = 3.0, 95% CI = 1.6-5.6, p < 0.001). The prevalence of advanced liver fibrosis was 25.5%. Independent factors associated with advanced liver fibrosis were male gender (aOR = 1.8, 95% CI = 1.0-3.0, p < 0.05), elevated waist circumference (aOR = 2.0, 95% CI = 1.0-4.0, p < 0.05), low platelet count (aOR = 5.4, 95% CI = 2.7-11.0, p < 0.001), elevated GGT (aOR = 5.0, 95% CI = 2.9-8.8, p < 0.001), and MAFLD (aOR = 3.2, 95% CI = 1.7-5.9, p < 0.001). Conclusion:A high prevalence of MAFLD and advanced liver fibrosis was observed among hemodialysis patients. Nephrologists should consider a more proactive approach in diagnosing MAFLD and/or advanced liver fibrosis in hemodialysis patients. | INTRODUCTIONNonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver condition characterized by excess accumulation of fat in the liver in the absence of significant alcohol intake and other causes of chronic liver disease. 1 The majority of NAFLD cases are related to obesity and the metabolic syndrome. In 2020, the term metabolic dysfunction-associated fatty liver disease (MAFLD) was introduced

Is metabolic‐dysfunction‐associated fatty liver disease or advanced liver fibrosis associated with erythropoietin stimulating agent hypo‐responsiveness among patients with end‐stage kidney disease on haemodialysis?

“…Although MAFLD and ESKD share common aetiologies and pathophysiological processes, such as diabetes mellitus, overweight or obesity, hypertriglyceridemia, hypertension, and the metabolic syndrome, studies on the relationship between MAFLD and ESKD remain limited. Recently, we found a high prevalence of MAFLD and advanced liver fibrosis among our haemodialysis patients 6 . As mentioned earlier, MAFLD and/or advanced liver fibrosis may be potential factors associated with ESA hypo‐responsiveness among haemodialysis patients.…”

“…Recently, we found a high prevalence of MAFLD and advanced liver fibrosis among our haemodialysis patients. 6 As mentioned earlier, MAFLD and/or advanced liver fibrosis may be potential factors associated with ESA hypo-responsiveness among haemodialysis patients. The objective of this study was to determine whether ESA hypo-responsiveness is associated with MAFLD and/or advanced liver fibrosis among haemodialysis patients.…”