Prevalence and outcomes of chronic liver disease in patients receiving dialysis: systematic review and meta-analysis

Abstract

Background Patients receiving dialysis for end-stage kidney disease (ESKD) commonly co-exhibit risk factors for hepatic impairment. This systematic review and meta-analysis aimed to quantify the co-existence of chronic liver disease (CLD) and characterise risk factors and outcomes. Methods We searched the following databases from inception to May 2021: CINAHL, Cochrane Library, EMBASE, Kings Fund Library, MEDLINE and PubMed. The protocol was pre-registered on PROSPERO (study ID: CRD42020206486). Studies were assessed against three inclusion criteria: (1) adults (>18 years) with ESKD receiving dialysis (2) primary outcome involving CLD prevalence (3) publications in English. Moderator analysis was performed for age, gender, study size, and publication year. Sensitivity analysis was performed where applicable by removing outlier results and studies at high risk of bias. Results Searches yielded 7,195 articles, 15 met the inclusion criteria. 320,777 patients were included. Prevalence of cirrhosis and non-alcoholic fatty liver disease (NAFLD) was 5% and 55%, respectively. Individuals with CLD had two-fold higher mortality than those without (OR 2.19; 95% confidence interval 1.39-3.45). Hepatitis B (OR 13.47;1.37-132.55) and hepatitis C (OR 7.05; 4.00-12.45), but not diabetes, conferred increased cirrhosis risk. All studies examining NAFLD were judged to be at high risk of bias. We found no data on non-alcoholic steatohepatitis (NASH). Deaths from CLD, cancer and infection were greater amongst cirrhotic patients. Conclusions CLD is prevalent in dialysis patients. Hepatitis B and C confer increased risk of CLD. The impact of NAFLD and NASH cirrhosis requires further study. CLD associates with increased mortality risk in this setting.

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

“…In a study that included a cohort of 6,193 elderly patients admitted to acute medical wards between 2010 and 2018, 315 patients (5%) were diagnosed with cirrhosis[ 21 ]. Finally, a pooled meta-analysis including 15 studies with a total of 320777 patients suggested that among those receiving dialysis, the prevalence of cirrhosis was 5% and associated with higher mortality, with further analysis showing that hepatitis B and C, rather than diabetes, contributed to the increased risk of cirrhosis[ 22 ].…”

Outcomes after kidney transplant alone in patients with cirrhosis—A case‐control study

“…Chronic liver disease (CLD) often co-exists in patients with endstage renal disease (ESRD), with reported prevalence rates of 55% for metabolic dysfunction-associated steatotic liver disease (MASLD), 10% for hepatitis C virus (HCV) infections, and 1% for hepatitis B virus (HBV) infections. [1][2][3] Cirrhosis affects about 5% of patients with ESRD. 3 Kidney transplantation (KT) has demonstrated significant improvements in both quality of life and survival compared to dialysis, particularly in patients with ESRD and CLD, as observed in several studies.…”

“…[1][2][3] Cirrhosis affects about 5% of patients with ESRD. 3 Kidney transplantation (KT) has demonstrated significant improvements in both quality of life and survival compared to dialysis, particularly in patients with ESRD and CLD, as observed in several studies. [4][5][6] However, the presence of CLD has historically been associated with adverse graft outcomes and increased mortality after KT as compared to those without CLD.…”

“…Chronic liver disease (CLD) often co‐exists in patients with end‐stage renal disease (ESRD), with reported prevalence rates of 55% for metabolic dysfunction‐associated steatotic liver disease (MASLD), 10% for hepatitis C virus (HCV) infections, and 1% for hepatitis B virus (HBV) infections 1–3 . Cirrhosis affects about 5% of patients with ESRD 3 …”