Risk of Nephrolithiasis in Cirrhosis: A Comparison between MASLD Cirrhosis and Cirrhosis Due to Other Etiologies

Nephrolithiasis is a systemic condition influenced by metabolic disorders, with rising prevalence worldwide. Although several studies have investigated the relationship between metabolic-associated steatotic liver disease (MASLD) and nephrolithiasis, few have focused on cirrhosis-specific etiologies. As the epidemiology of cirrhosis shifts from viral and alcohol-related causes to metabolic dysfunction-related etiologies, understanding how these different causes influence the risk of nephrolithiasis is crucial. This study aims to evaluate the association between MASLD cirrhosis and nephrolithiasis, compared with other cirrhosis etiologies, using a nationally representative cohort.

We conducted a retrospective cohort study using the US National Inpatient Sample from 2016 to 2020. Patients aged 18 years and older with a diagnosis of cirrhosis were included. Cirrhosis etiologies were categorized as MASLD cirrhosis and non-MASLD cirrhosis (including alcohol, chronic viral hepatitis, and other causes). The primary outcome was attaining a diagnosis of nephrolithiasis. Propensity score matching was performed to balance covariates between groups. Multivariate logistic regression models were used to estimate adjusted odds ratios (aORs) for nephrolithiasis risk, accounting for demographics, comorbidities and hospital characteristics. Sensitivity analysis using the E-value was conducted to assess robustness of the findings.

In total, 112,312 patients with cirrhosis were included after matching; 56,156 patients were classified with MASLD cirrhosis and 56,156 with non-MASLD cirrhosis. The mean age of patients in the matched cohort was 64.2 ± 11.48 years, with 39.5% being male. Patients with MASLD cirrhosis were less likely to have Medicaid (12.0% vs 17.5%) (P < 0.0001) or to be from lower-income households (31.8% vs 35.3%) compared with those with cirrhosis of other etiologies (P < 0.0001). In multivariate analysis, MASLD cirrhosis was associated with a significantly higher risk of nephrolithiasis compared with non-MASLD cirrhosis (aOR 1.229, 95% confidence interval [CI] 1.093-1.383, P < 0.0001). Subgroup analysis revealed that the risk of nephrolithiasis was significantly higher in MASLD cirrhosis compared with alcohol-related cirrhosis (aOR 1.328, 95% CI 1.053-1.692, P = 0.020), and to other cirrhosis types (aOR 1.147, 95% CI 1.010-1.305, P = 0.035), but not significantly different from viral hepatitis-related cirrhosis (aOR 1.124, 95% CI 0.894-1.429, P = 0.33). Sensitivity analysis using the E-value indicated that an unmeasured confounder would need to have an odds ratio of at least 1.76 to explain for the observed association.

MASLD cirrhosis is associated with a higher risk of nephrolithiasis than cirrhosis of other etiologies. Our findings underscore the need for tailored nephrolithiasis screening and management strategies for patients with MASLD cirrhosis, particularly as the burden of metabolic-related liver disease continues to rise.