Is the metabolic dysfunction-associated steatotic liver disease a predictor of chronic kidney disease?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a multisystem disorder strongly associated with metabolic dysfunction. Emerging evidence suggests a close association between MASLD and chronic kidney disease (CKD). However, the magnitude and determinants of renal involvement remain inconsistent across studies, particularly in relation to diabetes mellitus (DM) and hepatic fibrosis.

To assess the association between CKD and MASLD and identify the predictors of renal impairment in patients with MASLD.

A case-control study was conducted in the Internal Medicine Department, Faculty of Medicine, Assiut University, Egypt, between March 2024 and March 2025. It included 150 participants recruited from outpatient clinics. Participants were divided into three groups: Those with MASLD and type 2 DM (n = 50), those with MASLD without DM (n = 50), and healthy controls (n = 50). All participants underwent clinical and laboratory evaluation. Additionally, they were assessed for insulin resistance using Homeostasis Model Assessment of Insulin Resistance, abdominal ultrasound, and FibroScan. CKD was defined based on the estimated glomerular filtration rate and albuminuria. Multivariate logistic regression was used to assess the factors associated with CKD in patients with MASLD.

The three groups were similar in terms of mean age (P = 0.102) and gender (P = 0.553) distribution of the participants. However, the incidence of hypertension and ischemic heart disease was significantly higher in patients with MASLD than in those without. Patients with MASLD exhibited significantly higher serum creatinine, urea, and albuminuria levels, along with lower estimated glomerular filtration rate (P < 0.001). Advanced hepatic fibrosis was more prevalent in MASLD with DM, with F3-F4 fibrosis observed in 50% of patients compared to 14% in those with MASLD without DM. The severity of fibrosis and steatosis increased progressively with advancing CKD stage (P < 0.001). Factors associated with CKD included hepatic fibrosis score [odds ratio (OR) = 5.61], steatosis score (OR = 4.17), Homeostasis Model Assessment of Insulin Resistance (OR = 4.15), DM (OR = 3.10), and obesity (OR = 2.37).

MASLD is associated with CKD, particularly in patients with DM and advanced hepatic fibrosis. Incorporating non-invasive liver fibrosis assessment may aid in the early identification of patients with MASLD who are at a high risk of renal disease.