Fatty liver associated with metabolic derangement in patients with chronic kidney disease: A controlled attenuation parameter study

Abstract

Background: Hepatic steatosis measured with controlled attenuation parameter (CAP) using transient elastography predicts metabolic syndrome in the general population. We investigated whether CAP predicted metabolic syndrome in chronic kidney disease patients.

Methods: CAP was measured with transient elastography in 465 predialysis chronic kidney disease patients (mean age, 57.5 years).

Results: The median CAP value was 239 (202-274) dB/m. In 195 (41.9%) patients with metabolic syndrome, diabetes mellitus was more prevalent (105 [53.8%] vs. 71 [26.3%], P < 0.001), with significantly increased urine albumin-to-creatinine ratio (184 [38-706] vs. 56 [16-408] mg/g Cr, P = 0.003), high sensitivity C-reactive protein levels (5.4 [1.4-28.2] vs. 1.7 [0.6-9.9] mg/L, P < 0.001), and CAP (248 [210-302] vs. 226 [196-259] dB/m, P < 0.001). In multiple linear regression analysis, CAP was independently related to body mass index (β = 0.742, P < 0.001), triglyceride levels (β = 2.034, P < 0.001), estimated glomerular filtration rate (β = 0.316, P = 0.001), serum albumin (β = 1.386, P < 0.001), alanine aminotransferase (β = 0.064, P = 0.029), and total bilirubin (β = -0.881, P = 0.009). In multiple logistic regression analysis, increased CAP was independently associated with increased metabolic syndrome risk (per 10 dB/m increase; odds ratio, 1.093; 95% confidence interval, 1.009-1.183; P = 0.029) even after adjusting for multiple confounding factors.

Conclusion: Increased CAP measured with transient elastography significantly correlated with and could predict increased metabolic syndrome risk in chronic kidney disease patients.

Keywords: Chronic kidney disease; Hepatic steatosis; Metabolic syndrome; Transient elastography.

Figure 1. Flow diagram of the study

CKD, chronic kidney disease; IQR, interquartile range; LS, liver stiffness; M, median.

Figure 2. A cubic spline curves for the presence of metabolic syndrome according to the degree of CAP values in patients with chronic kidney disease

The models were adjusted for age, gender, history of diabetes mellitus and hypertension, total bilirubin, serum albumin, eGFR, UACR, hs-CRP, and HDL-C. The solid line represents the log odds of metabolic syndrome according to CAP, and the dotted line representes 95% CI. CAP, controlled attenuation parameter; CI, confidence interval; eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; hs-CRP, high sensitivity C-reactive protein; UACR, urine albumin-to-creatinine ratio.

Figure 3. Controlled attenuation parameter according to the number of metabolic syndrome (MS) components

Each bar represents the mean and 95% confidence interval. Controlled attenuation parameter values increased in parallel with the number of metabolic syndrome components (P < 0.001). CAP, controlled attenuation parameter.

Figure 4. The proportions of metabolic factors which satisfy the criteria of metabolic syndrome (MS) according to the dichotomized CAP

Among the five diagnostic criteria of MS, BMI (27.7% vs. 72.3%, P < 0.001) and TG (32.5% vs. 67.5%, P < 0.001) showed significant higher proportions in the higher CAP group than the lower CAP group, but fasting plasma glucose, HDL-C, and SBP did not show differences between the two groups. BMI, body mass index; CAP, controlled attenuation parameter; HDL-C, high-density lipoprotein cholesterol; SBP, systolic blood pressure; TG, triglyceride.