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

Abstract

Background and aimsControlled attenuation parameter (CAP) is a non-invasive method for measuring hepatic steatosis (HS). Non-alcoholic fatty liver disease (NAFLD) is closely related to cardiovascular diseases (CVDs). CVDs are the leading cause of morbidity and mortality in hemodialysis patients. The aim of this study was to investigate the prevalence of NAFLD in hemodialysis patients.MethodWe prospectively enrolled patients undergoing chronic hemodialysis, as well as patients with normal renal function who served as controls. The control group patients were referred by an endocrinologist to be tested for NAFLD; most of these patients had diabetes, hypertension, or dyslipidemia. We excluded those with excess alcohol intake, use of drugs known to induce HS, chronic viral hepatitis, or CAP failure. CAP ≥ 238 dB/m was used as a cutoff suggesting HS. An increased liver kidney contrast, as defined by ultrasound, was used to make the diagnosis of HS.ResultsThree hundred and forty-three hemodialysis patients and 252 control group patients were enrolled. Among the hemodialysis patients, 192 (56.0%) had CAP- or ultrasound-identified HS compared with 91 (26.5%) who only had ultrasound-identified HS (P<0.001). Among the control group patients, 212 (84.1%) had CAP- or ultrasound-identified HS compared with 180 (71.4%) who only had ultrasound-identified HS (P<0.001).ConclusionsThe prevalence of NAFLD in the hemodialysis patients was 56%. The number of diagnoses of NAFLD made by using CAP combined with ultrasound was more than 2 times the number made with ultrasound alone in the hemodialysis patients. Therefore, we suggest the use of CAP combined with ultrasound to screen for NAFLD in hemodialysis patients.

Effect of Empagliflozin on Liver Steatosis and Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease Without Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial

“…Grade 1 steatosis (S1) was defined as CAP between 238 dB/m and 259 dB/m. CAP score between 260 dB/m and 291 dB/m was considered as S2, and 292 dB/m or higher was defined as S3 [12,13]. In addition, recent cutoff values were also considered: 302 dB/m, 331 dB/m, and 337 dB/m, for S1, S2, and S3, respectively [11].…”

Oxidative Stress and Nonalcoholic Fatty Liver Disease in Hemodialysis Patients

“…In addition to the traditional risk factors such as diabetes, hypertension, and dyslipidemia, dialysis patients have many nontraditional cardiovascular risk factors, including vascular calcification, oxidative stress, protein-energy wasting, uremic toxins, hyperparathyroidism, and dialysis procedures [ 3 , 4 ]. Our previous reports showed that nonalcoholic fatty liver disease (NAFLD) is a novel and independent risk factor associated with cardiovascular event in HD patients [ 5 , 6 ].…”

Correlation of the grade of hepatic steatosis between controlled attenuation parameter and ultrasound in patients with fatty liver: a multi-center retrospective cohort study

“…With respect to the diagnostic accuracy of the CAP, Ahn et al [ 9 ] reported AUROC values of 0.789 and 0.843 for grades 2 and 3 steatosis, respectively. Yen et al [ 32 ] also reported AUROC values of 0.716 and 0.701 for moderate and severe steatosis, respectively, in NAFLD patients. Our study showed high accuracy for grade 2 to 3 (AUROC, 0.749) and grade 3 (AUROC, 0.738) steatosis.…”