Metabolic Dysfunction-Associated Steatotic Liver Disease Is Associated with Increased Risk of Kidney Cancer: A Nationwide Study

<b>Background</b>: This study investigated the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and Kidney Cancer Risk, as the incidence of both diseases gradually increases owing to metabolic health issues. <b>Methods</b>: Participants (aged 20-79) undergoing a national health examination between 2009 and 2010 were monitored for new-onset kidney cancer. The MASLD spectrum was classified as non-MASLD, MASLD, or MASLD with increased alcohol uptake (MetALD). Kidney Cancer Risk associated with the MASLD spectrum was estimated using multivariate Cox proportional hazard models. Age- and sex-stratified analyses were also performed. <b>Results</b>: Among 8,829,510 participants (median follow-up 13.3 years), the proportion of non-MASLD, MASLD, and MetALD was 64.9%, 30.3%, and 4.7%, respectively, with newly developed kidney cancer in 17,555 participants. Kidney cancer was significantly increased with MASLD (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.46-1.56) and MetALD (aHR 1.51, 95% CI 1.42-1.61), compared with the non-MASLD group. Kidney Cancer Risk was the highest among young populations (aHR 1.93, 95% CI 1.77-2.11 for MASLD and aHR 1.91, 95% CI 1.65-2.22 for MetALD), according to stratification analysis. Furthermore, the cumulative relationship between metabolic dysfunction and Kidney Cancer Risk was confirmed across all MASLD spectra. <b>Conclusions</b>: Our study highlights the positive association between MASLD and Kidney Cancer Risk, emphasizing a comprehensive approach to metabolic health. This also serves as a call to devote closer attention to the metabolic health of younger patients.