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Abstract: FR-PO910

Correlation Between Fibrosis-4 Index and Renal Dysfunction but Limited Causality

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention


  • Araki, Makoto, Sapporo Tokushukai Hospital, Sapporo, Hokkaido, Japan

Metabolic dysfunction-associated fatty liver disease has been increasing, with the high prevalence of renal dysfunction complications suggesting a causal relationship. Therefore, we examined whether the fibrosis-4 index (Fib4 index), a well-known marker of liver fibrosis, had a direct effect on CKD.


This single-institutional observational study screened subjects measured simultaneously for creatinine, aspartate aminotransferase, alanine aminotransferase, and platelet levels during annual physical examinations between 2012 and 2021. Those younger than 18 years, undergoing dialysis, and having blood test results for only 1 year were excluded. Patients were then divided into high and low Fib4 index groups based on a cutoff of 1.3, as previously reported, and compared in terms of renal function changes. Both groups were evaluated using time-to-event analysis in terms of a 30% and 40% estimated glomerular filtration rate (eGFR) decline.


Among the 93,404 individuals initially assessed, 5,906 satisfied the criteria (mean observation period: 1654 days). High Fib4 index levels were correlated with age (4% of patients under 50 years old; 93% of patients over 70 years old). Univariate analysis via the Lon-rank test showed that the high Fib4 index group had significantly worse renal function (Figure), although both groups had a mean age difference of 10 years. Therefore, after adjusting for sex, age, and eGFR in the first year, mean observation period, and number of patients with diabetes using propensity score matching, the difference between both groups nearly disappeared although a significant trend remained (Figure). Furthermore, on multivariate Cox regression analysis, significant findings were found for age and presence of diabetes but not the Fib4 index.


Although the Fib4 index was correlated with renal dysfunction, no causal relationship surpassed age or the presence of diabetes in our study.