Association of Metabolic Dysfunction-Associated Steatotic Liver Disease and Kidney Failure in the CKD Population

BackgroundWhile fatty liver disease is a known risk factor for chronic kidney disease (CKD), its association with kidney failure remains unclear, especially after redefined as metabolic dysfunction-associated steatotic liver disease (MASLD).We aimed to quantify the association between MASLD and kidney failure in the CKD population by generating epidemiological data. MethodsWe utilized 187,881 individuals with CKD from medical screening data of National Health Insurance Service (NHIS) database of Korea.The population was categorized with no steatotic liver disease, MASLD, MASLD with increased alcohol intake, and alcoholic liver disease or steatotic liver disease with other specific etiologies.The risk of kidney failure was analyzed using Cox proportional hazard models adjusting demographic and clinical variables. ResultsThe study population had mean age of 63.3 years old with 58% females.During median of 9.28 (9.03, 9.63) years of follow-up, 7497 (4%) kidney failure were identified.In the adjusted model, the "MASLD" group showed higher risk of kidney failure [HR 1.146 (1.078, 1.219)] compared to "no steatotic liver disease".However, "MASLD with increased alcohol intake" [HR 0.981 (0.834, 1.154)] or "alcoholic liver disease or steatotic liver disease with other specific etiologies" [HR 1.098, (0.991, 1.216) showed nonsignificant difference.The association between MASLD and kidney failure was particularly accentuated in females [HR 1.301 (1.192, 1.420)], old age, non-hypertension, non-albuminuria, and non-smoking subgroup. Conclusion J o u r n a l P r e -p r o o fIn this large-scale observational study, MASLD was associated with kidney failure in individuals with CKD.Our findings highlight the importance of risk stratification in certain patients to prevent kidney failure.