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

Table 1 Classification of chronic kidney disease into five stages based on the glomerular filtration rate reduction and degree of proteinuria[10]

Stage	Description of the stage	eGFR (mL/minute/1.73 m²)
1	Kidney damage with normal or increased GFR	≥ 90
2	Kidney damage with mildly decreased GFR	60-90
3	Moderately decreased GFR	30-59
4	Severely decreased GFR	15-29
5	End-stage renal disease	< 15 or dialysis

eGFR: Estimated glomerular filtration rate.

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Table 2 Demographic and baseline clinical characteristics of patients and control groups, mean ± SD/n (%)

Variables	MASLD with DM (n = 50)	MASLD without DM (n = 50)	Control group (n = 50)	P value
Age (years)	46.53 ± 3.89	42.65 ± 13.90	43.98 ± 12.01	0.104
Sex				0.550
Male	34 (68)	38 (74)	37 (74)
Female	16 (32)	12 (24)	13 (26)
BMI (kg/m²)	28.18 ± 3.22	27.01 ± 4.30	22.10 ± 3.33	< 0.001
Residence				0.511
Rural	30 (60)	34 (68)	35 (70)
Urban	20 (40)	16 (32)	15 (30)
Smoking status				0.856
Smoker	9 (18)	10 (20)	12 (24)
Ex-smoker	15 (30)	15 (30)	8 (16)
Passive smoker	7 (14)	10 (20)	9 (18)
None	19 (38)	15 (30)	21 (42)
Hypertension	12 (24)	3 (6)	0	< 0.001
IHD	2 (4)	0	0	< 0.001
Pulse (b/minute)	83.09 ± 12.45	80.09 ± 10.34	80 ± 8.76	0.406
SBP (mmHg)	121.76 ± 18.89	118.90 ± 22.18	117 ± 14.67	0.076
DBP (mmHg)	75.40 ± 8.55	71.18 ± 7.19	70.13 ± 6.66	0.562

BMI: Body mass index; DBP: Diastolic blood pressure; DM: Diabetes mellitus; IHD: Ischemic heart disease; MASLD: Metabolic dysfunction-associated steatotic disease; SBP: Systolic blood pressure.

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Table 3 Laboratory characteristics of patient and control groups, mean ± SD

Variables	MASLD with DM (n = 50)	MASLD without DM (n = 50)	Control group (n = 50)	P value
Hb (g/dL)	12.03 ± 1.23	12.09 ± 2.87	12.45 ± 2.42	0.542
Platelets (10³/uL)	290.10 ± 55.90	312.98 ± 46.99	302.08 ± 67.54	0.206
Leucocytes (10³/uL)	6.67 ± 2.01	7.617 ± 2.35	7.01 ± 2.98	0.105
PLR	208.45 ± 45.78	201.21 ± 55.09	134.29 ± 32.90	< 0.001
NLR	2.39 ± 0.98	2.22 ± 0.76	1.20 ± 0.50	< 0.001
FBS (mg/dL)	228.17 ± 40.45	158.22 ± 39.10	148.76 ± 54.56	< 0.001
Glycosylated Hb (%)	7.67 ± 0.27	5.17 ± 0.24	5.20 ± 0.36	< 0.001
INR	1.02 ± 0.01	1.01 ± 0.01	1.01 ± 0.01	0.395
Sodium (mmol/L)	134 ± 0.19	133.5 ± 0.18	133.10 ± 0.04	0.085
Potassium (mmol/L)	3.98 ± 0.57	4.24 ± 0.55	4.01 ±0.30	0.212
Cholesterol (mg/dL)	221.09 ± 22.05	210.45 ± 18.98	154.23 ± 34.09	< 0.001
Triglycerides (mg/dL)	134.30 ± 29.76	114.10 ± 21.10	101.22 ± 19.14	< 0.001
LDL (mg/dL)	128.19 ± 38.19	123.11 ± 33.47	98.10 ± 29.50	0.011
HDL (mg/dL)	47.80 ± 4.59	48.79 ± 4.12	50.56 ± 5.42	0.761
AST (u/L)	89.18 ± 15.43	79.18 ± 10.45	22.70 ± 3.87	< 0.001
ALT (u/L)	78.11 ± 6.66	68.11 ± 7.69	27.56 ± 5.10	< 0.001
Albumin (mg/dL)	3.79 ± 0.59	3.80 ± 0.36	3.98 ± 0.40	0.198
Bilirubin (mg/dL)	1.09 ± 0.12	1.18 ± 0.18	0.99 ± 0.11	0.464
CRP (mg/dL)	2.45 ± 2.45	2.12 ± 0.68	2 ± 1.20	0.173
ESR (mL/hour)	15.28 ± 3.01	11.28 ± 2.10	6.70 ± 2.18	0.472
HOMA-IR	2.89 ± 1.21	1.34 ± 0.87	1.31 ± 0.23	< 0.001

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CRP: C-reactive protein; DM: Diabetes mellitus; ESR: Erythrocyte sedimentation rate; FBS: Fasting blood sugar; Hb: Hemoglobin; HDL: High density lipoproteins; HOMA-IR: Homeostasis Model Assessment of Insulin Resistance; INR: International normalized ratio; LDL: Low density lipoproteins; MASLD: Metabolic dysfunction-associated steatotic liver disease; NLR: Neutrophil/Lymphocyte ratio; PLR: Platelets/Lymphocyte ratio.

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Table 4 Kidney function tests in patients with and without diabetes mellitus and control groups, mean ± SD

Variables	MASLD with DM (n = 50)	MASLD without DM (n = 50)	Control group (n = 50)	P value
Urea (mg/dL)	21.19 ± 8.97	16.19 ± 3.11	10.24 ± 3.49	< 0.001
Creatinine (mg/dL)	1.75 ± 0.60	1.35 ± 0.76	0.79 ± 0.13	< 0.001
eGFR (mL/minute)	79.09 ± 7.98	85.98 ± 8.70	101.76 ± 2.34	< 0.001
Albuminuria (mg/day)	78.17 ± 12.87	34.19 ± 5.55	12.90 ± 4.12	< 0.001

eGFR: Estimated glomerular filtration rate; DM: Diabetes mellitus; MASLD: Metabolic dysfunction-associated Steatotic liver disease.

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Table 5 Fibrosis parameters and FibroScan assessment in patients and control groups, mean ± SD/n (%)

Variables	MASLD with DM (n = 50)	MASLD without DM (n = 50)	Control group (n = 50)	P value
FIB-4	3.49 ± 1.09	2.80 ± 0.87	1.29 ± 0.40	< 0.001
APRI	1.55 ± 0.29	1.41 ± 0.34	1.04 ± 0.39	< 0.001
FibroScan score	13.01 ± 3.49	10.69 ± 5.44	4.76 ± 0.27	< 0.001
Degree of fibrosis				0.001
F0	5 (10)	13 (26)	45 (90)
F1	9 (18)	20 (40)	5 (10)
F2	11 (22)	10 (20)	0
F3	12 (24)	5 (10)	0
F4	13 (26)	2 (4)	0
Steatosis score	282.11 ± 45.67	208.33 ± 55.90	178.09 ± 23.10	< 0.001
Degree of steatosis				0.010
S0	3 (6)	8 (16)	39 (78)
S1	11 (22)	13 (26)	11 (22)
S2	15 (30)	13 (26)	0
S3	21 (22)	16 (32)	0

APRI: Aspartate aminotransferase to platelet ratio index; FIB-4: Fibrosis-4 index; MASLD: Metabolic dysfunction-associated steatotic liver disease; DM: Diabetes mellitus; F: Fibrosis; S: Steatosis.

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Table 6 Degree of fibrosis and steatosis based on the stage of chronic kidney disease, mean ± SD/n (%)

Variables	CKD stage-I (n = 9)	CKD stage-II (n = 6)	CKD stage-III (n = 5)	P value
FIB-4	2.55 ± 0.65	3.01 ± 0.68	3.60 ± 0.78	< 0.001
APRI	1.22 ± 0.39	1.51 ± 0.80	1.85 ± 0.40	< 0.001
FibroScan score	8.01 ± 3.90	11.33 ± 4.19	16.76 ± 3.33	< 0.001
Degree of fibrosis				0.001
F0	2 (22.2)	1 (16.7)	0
F1	4 (44.4)	2 (33.3)	0
F2	3 (33.4)	1 (16.7)	1 (20)
F3	0	1 (16.7)	2 (40)
F4	0	1 (16.7)	2 (40)
Steatosis score	218.09 ± 44.40	235.90 ± 78.70	292.21 ± 66.89	< 0.001
Degree of steatosis				0.013
S0	3 (33.4)	1 (16.7)	0
S1	2 (22.2)	2 (33.3)	0
S2	2 (22.2)	2 (33.3)	2 (40)
S3	2 (22.2)	1 (16.7)	3 (60)

APRI: Aspartate aminotransferase to platelet ratio index; CKD: Chronic kidney disease; FIB-4: Fibrosis-4 index; F: Fibrosis; S: Steatosis.

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Table 7 Multivariate regression analysis of the risk factors of chronic kidney disease in patients with metabolic dysfunction-associated steatotic liver disease

Variables	Odds ratio	95%CI	P value
Old age (years)	1.19	0.45-2.78	0.402
Sex	1.03	0.90-3.14	0.316
Obesity	2.37	1.67-7.89	0.012
Diabetes mellitus	3.10	2.39-8.19	< 0.001
PLR (> 150)	2.90	1.18-5.17	0.010
NLR (> 3)	2.17	1.22-6.01	< 0.001
HOMA-IR	4.15	2.90-11.19	< 0.001
FIB-4 (> 3.25)	3.56	2.78-9.18	< 0.001
Fibrosis score > F2	5.61	3.45-13.90	< 0.001
Steatosis score > S3	4.17	2.23-10.56	< 0.001

CI: Confidence interval; FIB-4: Fibrosis-4 index; HOMA-IR: Homeostasis Model Assessment of Insulin Resistance; NLR: Neutrophil/Lymphocyte ratio; PLR: Platelets/Lymphocyte ratio; F: Fibrosis; S: Steatosis.

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Citation: Azoz NM, Shehata MA, Abbas WA, Gadelkareem RA, Abdel Aziz EM. Is the metabolic dysfunction-associated steatotic liver disease a predictor of chronic kidney disease? World J Nephrol 2026; 15(2): 118877
URL: https://www.wjgnet.com/2220-6124/full/v15/i2/118877.htm
DOI: https://dx.doi.org/10.5527/wjn.v15.i2.118877

Azoz NM, Shehata MA, Abbas WA, Gadelkareem RA, Abdel Aziz EM. Is the metabolic dysfunction-associated steatotic liver disease a predictor of chronic kidney disease? World J Nephrol 2026; 15(2): 118877 [DOI: 10.5527/wjn.v15.i2.118877]

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