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Abstract: SA-PO567

Noninvasive Assessment of Liver Disease and Outcomes in ESKD

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Swift, Oscar, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Finkelman, Malcolm A., Associates Of Cape Cod Inc, East Falmouth, Massachusetts, United States
  • Zhang, Yonglong, Associates Of Cape Cod Inc, East Falmouth, Massachusetts, United States
  • Javier, Chadd, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Gilbert, Mikky Marshal, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Mccafferty, Kieran, Barts Health NHS Trust, London, London, United Kingdom
  • Wong, Jonathan P., Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom
  • Warwicker, Paul, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
  • Patrick, Jean, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, United Kingdom
  • Winnett, Georgia, Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom
  • Balasubramaniam, Gowrie, Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom
  • Warburton, Richard Charles, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Sridharan, Sivakumar, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Farrington, Ken, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Vilar, Enric, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
Background

People with ESKD often exhibit risk factors (diabetes mellitus, obesity and hypertension) for non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH). NAFLD and NASH both associate with increased cardiovascular risk and by 2030 NASH will be the leading cause of cirrhosis.

Little is known about prevalence and clinical outcomes of NAFLD and NASH in ESKD.

We report updated interim results from this study non-invasively evaluating liver disease in ESKD.

Methods

This prospective observational study involves 451 prevalent patients with ESKD receiving dialysis for >3 months at 5 UK kidney units.

A FibroScan (Echosens) measured hepatic steatosis using controlled attenuation parametrography and fibrosis using transient elastography.

Survival analyses were performed using Kaplan-Meier estimates and a Cox regression model for multivariate analysis.

Results

Median patient age was 62. 61% of patients were male. 93% had hypertension, 48% diabetes and 63% hyperlipidaemia. 33% had a BMI of greater than 30kg/m2.

27% had suspected NAFLD and 12% suspected NASH.

There was increased mortality with suspected hepatic fibrosis grades F2-4 (19.1% vs 2.5% in grades F0-1). Kaplan-Meier survival curves are shown in Figure 1.

Mortality in participants with suspected hepatic fibrosis grades F3-4 was significantly increased after adjustment for other predictors of survival (Figure 2).

Conclusion

There is significant burden of suspected hepatic steatosis and fibrosis in ESKD. Suspected F3-4 fibrosis is an independent risk factor for mortality in this interim analysis. Strategies to improve liver health in advanced kidney disease may be of benefit.

Funding

  • Commercial Support – Associates of Cape Cod, Inc