Relationship between non‐alcoholic fatty liver disease and MIA syndrome

Abstract

Non-alcoholic fatty liver disease (NAFLD) is an important factor in the pathogenesis of cardiovascular diseases in the general population. Recently, it has been shown that NAFLD is highly prevalent in chronic kidney disease (CKD) patients. Ninety-four hemodialysis (HD) patients were followed for a time period of 18 months or until death. Patient's survival rate was determined in relation to their nutritional and inflammatory state, and the presence of NAFLD. We also investigated the association between the presence of NAFLD and the patients' nutritional and inflammatory state. We did not find any significant association between the clinical parameters of nutritional status and the mortality rate. However, the mortality rate was statistically significantly higher in patients with low serum albumin and high high-sensitive C-reactive protein (hs-CRP) levels and in those who had NAFLD. Surprisingly, patients who had received enteral nutrition did not have a better survival rate. The severity of liver steatosis was negatively correlated with the serum albumin levels, while it was positively correlated with hs-CRP values. Furthermore, serum albumin levels showed a negative correlation with hs-CRP levels. We did not find any significant association between the presence of NAFLD and clinical parameters of nutrition. We have shown that NAFLD could be one more possible example of reverse epidemiology in patients undergoing HD. NAFLD may be the missing link that causally ties malnutrition, inflammation, and atherosclerosis syndrome to the morbidity and mortality in patients undergoing HD.

Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study

“…The cause of this discrepancy between those previous studies and our study may be our study’s enrollment of much younger patients. The mean ages of the patients in the two previous studies were 75.1±7.1 years and 69.1±12 years, respectively [20,21]. In contrast, the mean age of the hemodialysis patients in this study was 63.2±12.3 years.…”

“…Additionally, the presence of NAFLD, low serum albumin levels, and high serum C-reactive protein levels were strong predictors of poor outcome in those patients. As a result, the authors of those studies concluded that NAFLD probably interacts with malnutrition, inflammation, and atherosclerosis (MIA) syndrome in hemodialysis patients [20,21]. In contrast, BMI was still an independent factor associated with CAP-identified HS in the hemodialysis patients in our study.…”

“…Furthermore, two of those previous studies enrolled elderly hemodialysis patients, the majority of whom were receiving supportive enteral nutrition [20,21]. In those studies, CAP was negatively correlated with the nutritional parameter (serum albumin), and there was no association between CAP and obesity (as defined by BMI).…”

“…In contrast, the mean age of the hemodialysis patients in this study was 63.2±12.3 years. Elderly patients are at risk of malnutrition [28], and the majority of patients in the two previous studies were receiving supportive enteral nutrition [20,21], indicating that MIA syndrome was present in most of these patients. In contrast, most of the patients in our study were not receiving supportive enteral nutrition.…”

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

“…Baseline study characteristics are outlined in Table 1 . Six studies were performed in East Asia [ 15 , 16 , 20–22 , 28 ], five in Europe [ 14 , 17 , 19 , 25 , 26 ], two in the USA [ 18 , 24 ] and one in North Africa [ 27 ]. One study was multinational [ 23 ].…”