#1438 Population-based analysis of metabolic-associated steatotic liver disease as a risk factor for end-stage kidney disease in chronic kidney disease patients

Abstract Background and Aims Metabolic-associated steatotic liver disease (MASLD) is a newly introduced terminology for liver disease associated with metabolic dysfunction. The clinical significance of MASLD requires further investigation, particularly in patients with chronic kidney disease (CKD). Method We utilized the claims database of South Korea, which includes comprehensive health screening examination results, to identify MASLD and evaluate kidney function. A total of 190,025 CKD patients without a prior history of end-stage kidney disease were included in the analysis. We assessed the incidence of end-stage kidney disease (ESKD), defined as the initiation of dialysis or receipt of a kidney transplant. Multivariable Cox regression analysis was performed, adjusting for factors including age, sex, income, smoking status, physical activity, baseline estimated glomerular filtration rate (eGFR) or albuminuria, body mass index (BMI), total cholesterol, and alanine aminotransferase (ALT) levels. Results The mean age of the study population was 63.3 years. Among the participants, 63,833 patients had MASLD, while 93,348 had no evidence of steatotic liver disease (SLD). Additionally, 3,600 patients had metabolic-associated liver disease (MetALD), and 6,926 had alcohol-associated liver disease (ALD). In terms of ESKD risk, the MASLD group showed a significantly higher risk (HR 1.15, 95% CI 1.08–1.22). Conversely, the risk was not elevated in the MetALD group (HR 0.98, 95% CI 0.83–1.15) or the ALD group (HR 1.10, 95% CI 0.99–1.22). Subgroup analyses revealed that the increased risk was more pronounced in females (HR 1.61, 95% CI 1.49–1.73) than in males (HR 0.96, 95% CI 0.90–1.02), with a significant interaction term (P < 0.001). Conclusion MASLD is a significant risk factor for ESKD in CKD patients, particularly among females. Clinicians should be aware of this elevated risk when managing CKD patients with MASLD.