NAFLD IN ESRD – PREVALENCE OF NAFLD IN ESRD PATIENTS AND EVALUATION OF THERAPEUTIC EFFICACY OF TOCOTRIENOL IN TREATMENT OF NADFLD

Introduction:

The Prevalence of NAFLD (Non Alcoholic Fatty Liver Disease) currently known as MASLD (Metabolic dysfunction-associated Steatotic Liver Disease) is estimated to be around 32% globally with one in 3 people suspected to have NAFLD. In this study, we evaluated the prevalence of NAFLD in ESRD patients undergoing dialysis using advanced Transient Elastography (TE) technique. We also studied the therapeutic effects of Tocotrienol ( Vitamin E) in improving NAFLD parameters. Vitamin E is recommended by the American Association for the Study of Liver Diseases(AASLD) in non- diabetic NAFLD patients. This is the first study evaluating the therapeutic effects of Tocotrienol in kidney disease patients with NAFLD.

Methods:

This prospective study enrolled 120 ESRD patients undergoing hemodialysis at a single Dialysis center in Chennai, India. Initial Liver screening was done using Transient Elastography (TE) technique with a Fibrotouch machine (FT 100). Ultrasound Attenuation Parameter (UAP score) which provides a quantitative measure of hepatic steatosis and Liver Stiffness Measurement(LSM) was measured. LFTs and other labs were checked at baseline and study completion. Risk factors including Diabetes, Hypertension, Obesity, Hepatitis B, Hepatitis C were evaluated. Patients with a UAP score above 250 dB/m (n=39) indicative of NAFLD received 200mg Tocotrienol twice daily for three months.  Primary outcomes included changes in SGPT, UAP and liver stiffness analysed using multivariate regression and descriptive statistics. The effect of Tocotrienol in improving UAP, Liver enzymes and liver stiffness was studied in detail.

Results:

NAFLD can progress from simple steatosis, steatohepatitis, fibrosis to cirrhosis. 35.8% of patients had a UAP value >238  db/m indicative of hepatic steatosis. Interestingly, 47.5% (without h/o of hep B and C) had liver stiffness scores >7 kPa indicating more advanced liver disease in ESRD patients. In addition, 71.7% of the patients had some form of occult liver disease with UAP> 238 db/m or liver stiffness >7 kPa or SGPT ( ALT) > 40.

Tocotrienol significantly improved UAP scores in 3 months, reducing the level by -27.96 (p < 0.001), suggesting a reduction in hepatic steatosis. Tocotrienol treatment also reduced SGPT levels with a coefficient of -9.69 (p = 0.045). The effect on liver stiffness was not statistically significant with a time point coefficient of 1.65 (p= 0.063) indicating only a minor change.

Conclusions:

The prevalence of NAFLD and advanced liver disease is higher in ESRD patients. Occult liver disease may be an additional comorbidity in these patients and needs to be studied further. Interestingly, Tocotrienol treatment demonstrated a beneficial effect on liver enzyme levels and hepatic steatosis. Tocotrienol may help manage liver related complications in advanced kidney disease patients.

I have potential conflict of interest to disclose.
Funding for the study was provided by Fourrts Laboratories

I did not use generative AI and AI-assisted technologies in the writing process.