Abstract: TH-PO0326
Association of the Fibrosis-4 Score with the Risk of Cardiovascular Disease and Death in Patients with CKD: Insights from the CRIC Study
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Correa, Simon, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Moloney, Brona, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Castro Loaiza, Valentina A, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Correa Gaviria, Tomas, Yale New Haven Health, New Haven, Connecticut, United States
- Mc Causland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
The Fibrosis-4 (FIB-4) score is used to estimate the risk of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). A higher FIB-4 score is associated with major adverse cardiovascular (CV) events in patients with MASLD, patients with pre-existing CV disease, and in the general population. However, the association of the FIB-4 score with adverse CV outcomes in patients with CKD is unclear.
Methods
Using adjusted Cox regression models, we explored the association of FIB-4 with a CV composite (myocardial infarction, stroke, heart failure), its individual components, and all-cause death among 5,386 patients with established CKD in the Chronic Renal Insufficiency Cohort (CRIC). FIB-4 was modeled continuously (log-transformed) and categorically (by tertiles). Adjusted cubic splines were fit to explore for non-linear associations.
Results
Median FIB-4 score was 1.13 [25, 75th percentile 0.83, 1.52], mean age 60±11 years, mean eGFR 48 ±16 mL/min/1.73m2. In adjusted analyses, higher FIB-4 score (per log-unit) was associated with a 29% higher risk of the CV composite (HR 1.29; 95%CI 1.13, 1.47), a 40% higher risk of HF (HR 1.40; 95%CI 1.18, 1.67), and a 52% higher risk of death (HR 1.52; 95%CI 1.36, 1.70) (Figure 1). Similar patterns were noted in categorical analyses, where those with highest tertile (vs. lowest) had a 31% higher risk of the CV composite (HR 1.31 95%CI 1.13, 1.52), a 51% higher risk of HF (HR 1.51; 95%CI 1.23, 1.85), and a 49% higher risk of death (HR 1.49, 95%CI 1.31, 1.70).
Conclusion
Among patients with CKD in CRIC, a higher FIB-4 score was associated with a higher risk of adverse CV outcomes and death. Whether a higher FIB-4 score identifies underlying liver disease among patients with CKD, and if this is on the causal pathway to adverse outcomes, warrants further investigation.