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

doi:10.5527/wjn.v15.i2.118877

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Jun 25, 2026; 15(2): 118877
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118877

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

Nashwa M Azoz, Marwa A Shehata, Wael A Abbas, Rabea A Gadelkareem, Essam M Abdel Aziz

Nashwa M Azoz, Essam M Abdel Aziz, Department of Internal Medicine-Nephrology Unit, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71711, Egypt

Marwa A Shehata, Department of Internal Medicine-Endocrinology Unit, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71711, Egypt

Wael A Abbas, Department of Internal Medicine-Gastroenterology Unit, Faculty of Medicine, Assuit University, Assuit 71511, Egypt

Rabea A Gadelkareem, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt

Author contributions: Azoz NM and Shehata MA designed the research, collected the data, and wrote the paper; Gadelkareem RA and Abdel Aziz EM contributed to the statistical analysis, literature review, writing, and revision; and Abbas WA contributed to the literature review, writing, revision, and supervision of the work. All authors have approved the manuscript.

Institutional review board statement: The proposal of this study was approved by the Ethics Committee of the Faculty of Medicine, Assiut University, Egypt, on November 9, 2023. The institutional review board number is No. 04-2023-200487.

Informed consent statement: All study participants provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STORBE Statement, and the manuscript was prepared and revised according to the STORBE Statement.

Data sharing statement: The raw data will be available from the authors on reasonable request.

Corresponding author: Rabea A Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. rabeagad@aun.edu.eg

Received: January 13, 2026
Revised: January 30, 2026
Accepted: March 2, 2026
Published online: June 25, 2026
Processing time: 153 Days and 15.9 Hours

Abstract

BACKGROUND

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.

AIM

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

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Chronic kidney disease; Diabetes mellitus; Hepatic fibrosis; Kidney injury; Metabolic dysfunction-associated steatotic liver disease; Obesity

Core Tip: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now recognized as a multisystem disease. It is closely linked to obesity, insulin resistance, type-2 diabetes mellitus (DM), dyslipidemia, and hypertension. The present case-control study revealed that MASLD is strongly associated with chronic kidney disease, particularly in patients with DM and advanced hepatic fibrosis. The factors associated with chronic kidney disease included hepatic fibrosis score, steatosis score, Homeostasis Model Assessment of Insulin Resistance, DM, and obesity. Incorporating liver fibrosis assessment using FibroScan may aid in the early identification of patients with MASLD who are at high risk for renal disease.