Association of noninvasive tests of liver fibrosis with chronic kidney disease in MASLD: a systematic review and meta-analysis

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Association of noninvasive tests of liver fibrosis with chronic kidney disease in MASLD: a systematic review and meta-analysis

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Co-author 1

Supatsri Sethasine supatsri@nmu.ac.th Faculty of Medicine,Vajira Hospital,Navamindradhiraj University Medicine Bangkok Thailand -

Co-author 2

Thananda Trakarnvanich thananda@nmu.ac.th Faculty of Medicine,Vajira Hospital,Navamindradhiraj University Medicine Bangkok Thailand *

Co-author 3

Witchakorn Ruamtawee witchakorn.rua@nmu.ac.th Faculty of Medicine,Vajira Hospital,Navamindradhiraj University Clinical Research Center, Research Facilitation Division Bangkok Thailand -

Co-author 4

Nutachat Treerasoradaj nutachat@nmu.ac.th Faculty of Medicine,Vajira Hospital,Navamindradhiraj University Urban Medicine Bangkok Thailand -

Co-author 5

Paweena Susantitaphong paweena.s@chula.ac.th 6Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University Medicine Bangkok Thailand -

Co-author 6

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Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging risk factor for chronic kidney disease (CKD). While liver biopsy is the gold standard for assessing fibrosis, noninvasive tests (NITs)—including fibrosis-4 (FIB-4), nonalcoholic fatty liver disease fibrosis score (NFS), and vibration-controlled transient elastography—are validated alternatives. However, their association with CKD stage in MASLD remains unclear. This study aimed to evaluate the association between NITs and various CKD outcomes in MASLD.

Methods

This study aimed to evaluate the association between NITs and various CKD outcomes in MASLD. A systematic search identified observational studies published between 2014-2024 following PRISMA were included. Data extraction and risk-of-bias assessment were performed independently by multiple reviewers. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model.

Results

Thirty-two studies comprising 278,355 MASLD were included. High FIB-4 were associated with increased risks of CKD stage ≥3 (adjusted OR (AOR): 2.23; 95%CI 1.40-3.53) and advanced CKD including ESRD (OR: 2.75; 95%CI 1.27-5.96). High NFS was associated with albuminuria (AOR: 1.68; 95%CI 1.19-2.38) and CKD stage ≥3 (AOR: 2.52; 95%CI 1.78-3.58).

Conclusion

Elevated liver stiffness showed a strong association with CKD stage ≥3 (AOR: 3.12; 95%CI 2.16-4.49). NITs may serve as indicators of CKD staging in MASLD. Future studies should explore whether targeting liver fibrosis could mitigate CKD progression.

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