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World J Hepatol. Jul 27, 2026; 18(7): 122926
Published online Jul 27, 2026. doi: 10.4254/wjh.122926
Time-dependent predictive accuracy of noninvasive liver scores for chronic kidney disease onset in metabolic dysfunction-associated steatotic liver disease
Huttakan Navadurong, Padoemwut Teerawongsakul, Thananda Trakarnvanich, Witchakorn Ruamtawee, Nutachat Treerasoradaj, Supatsri Sethasine
Huttakan Navadurong, Supatsri Sethasine, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Padoemwut Teerawongsakul, Division of Cardiology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Thananda Trakarnvanich, Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Witchakorn Ruamtawee, Clinical Research Center, Research Facilitation Division, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Nutachat Treerasoradaj, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Author contributions: Navadurong H contributed to conceptualization, investigation, methodology, and writing (original draft preparation, review, and editing); Teerawongsakul P contributed to data collection, data curation, methodology, validation, visualization; Trakarnwanich T contributed to validation and visualization; Ruamtawee W contributed to data curation and formal analyses; Treerasoradaj N contributed to data collection and data curation; Sethasine S contributed to conceptualization, investigation, methodology, and writing (review and editing).
AI contribution statement: The authors used Gemini to improve the English language and readability of the manuscript and Answering-Reviewers. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the final content of the manuscript.
Institutional review board statement: The study protocol was approved by the Vajira Institutional Review Board Institutional Review Board, Faculty of Medicine Vajira Hospital (COA 111/2567).
Informed consent statement: The informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data used in the current study are available from the corresponding author upon reasonable request.
Corresponding author: Supatsri Sethasine, MD, Associate Professor, Division of Gastro
enterology and Hepatology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Bangkok 10300, Thailand.
supatsri@nmu.ac.th
Received: May 6, 2026
Revised: June 2, 2026
Accepted: June 29, 2026
Published online: July 27, 2026
Processing time: 84 Days and 1.1 Hours
BACKGROUND
Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of developing chronic kidney disease (CKD) substantially. Although various noninvasive scoring systems have been validated for assessing liver fibrosis, their longitudinal performance in predicting time-dependent renal outcomes remains poorly characterized.
AIM
To evaluate and compare the prognostic performance of baseline noninvasive scores in predicting 5-year incident CKD in an MASLD cohort.
METHODS
This retrospective longitudinal study included 922 patients with MASLD. Baseline estimated glomerular filtration rate (eGFR) was recorded, with annual assessments performed over a 5-year follow-up period to identify CKD onset (defined as an eGFR < 60 mL/minute/1.73 m2). The prognostic accuracy of liver stiffness measurement (LSM), Fibrosis-4 (FIB-4) Index, Nonalcoholic fatty liver disease fibrosis score (NFS), and albumin-bilirubin (ALBI) score was evaluated via time-dependent area under the receiver operating characteristic (AUROC) curve analysis.
RESULTS
Over the 5-year period, 7.16% (n = 66) of the cohort developed CKD. The baseline NFS consistently outperformed other modalities in predicting cumulative CKD incidence. The NFS demonstrated robust discriminatory performance (AUROC, 0.73-0.79). In head-to-head comparisons, NFS was significantly superior to both LSM (AUROC, 0.64-0.67) and ALBI score (AUROC, 0.54-0.58) across nearly all time points. Although NFS was higher than the FIB-4 index (AUROC, 0.70-0.77), the difference was not statistically significant. Using a standard threshold of -1.455, NFS showed high sensitivity (approximately 89.1% after 3 years). Interestingly, the predictive capability of the NFS peaked at year 3 and then showed a slight progressive decline by years 4 and 5. In the adjusted models, both NFS and FIB-4 index remained independent predictors of CKD onset, whereas LSM lost its predictive significance by the end of the follow-up period.
CONCLUSION
Compared with LSM, FIB-4 index, and ALBI score, NFS is a superior and reliable noninvasive tool for predicting 5-year CKD onset in patients with MASLD. Considering its high sensitivity and reliance on routine clinical parameters, baseline NFS assessment can effectively identify high-risk patients, facilitating early nephrological intervention and individualized metabolic management.
Core Tip: Nonalcoholic fatty liver disease fibrosis score (NFS) is an independent and reliable predictor of 5-year incident chronic kidney disease in patients with metabolic dysfunction-associated steatotic liver disease. NFS demonstrated superior predictive accuracy compared with liver stiffness measurement and albumin-bilirubin score in this longitudinal study, with performance peaking at 3 years. Baseline NFS assessment should be incorporated into clinical practice to enable early identification of high-risk patients for nephrological intervention and individualized metabolic management.
