Kidney Week

Abstract: FR-PO1166

Clinical Utility of Fibrosis-4 Score for Assessing Albuminuria

Session Information

• CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Yongkiatkan, Panchanit, University of California Irvine, Irvine, California, United States

Panchanit Yongkiatkan, MD

• Bunyawannukul, Issaree, University of California Irvine, Irvine, United States

Issaree Bunyawannukul, MD

• Wongmat, Napat, University of California Irvine, Irvine, California, United States

Napat Wongmat, MD

• Wareesawetsuwan, Nicha, University of California Irvine, Irvine, California, United States

Nicha Wareesawetsuwan, MD

• Noree, Wanprapit, University of California Irvine, Irvine, California, United States

Wanprapit Noree, MD

• Puyati, Weerinth, University of California Irvine, Irvine, California, United States

Weerinth Puyati, MD

• Chamnarnphol, Natanon, University of California Irvine, Irvine, California, United States

Natanon Chamnarnphol, MD

• Mohpichai, Nopavit, University of California Irvine, Irvine, United States

Nopavit Mohpichai

• Gangeddula, Vishwaas Reddy, University of California Irvine, Irvine, California, United States

Vishwaas Reddy Gangeddula

• Kim, Seonghyeon, University of California Irvine, Irvine, California, United States

Seonghyeon Kim

• Shahnazarian, Christine T, University of California Irvine, Irvine, California, United States

Christine T Shahnazarian

• Massihians, Monique, University of California Irvine, Irvine, California, United States

Monique Massihians

• Lapadjyan, Mary E, University of California Irvine, Irvine, California, United States

Mary E Lapadjyan

• Liu, Yangjiayi, University of California Irvine, Irvine, California, United States

Yangjiayi Liu

• Ghaffarian, Bahaar S, University of California Irvine, Irvine, California, United States

Bahaar S Ghaffarian

• Kookanok, Chutawat, University of California Irvine, Irvine, California, United States

Chutawat Kookanok, MD

• Kulthamrongsri, Narathorn, University of California Irvine, Irvine, California, United States

Narathorn Kulthamrongsri, MD

• Wattanachayakul, Phuuwadith, University of California Irvine, Irvine, California, United States

Phuuwadith Wattanachayakul, MD

• Lee, Kyung hee, University of California Irvine, Irvine, California, United States

Kyung hee Lee, MD

• Supapwanich, Palakorn, University of California Irvine, Irvine, California, United States

Palakorn Supapwanich, MD

• Park, David, University of California Irvine, Irvine, California, United States

David Park

• Kantachuvesiri, Surasak, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

Surasak Kantachuvesiri, MD

• Tantisattamo, Ekamol, University of California Irvine, Irvine, United States

Ekamol Tantisattamo, MD, MPH, FASN

Background

Liver fibrosis and diabetes are risk factors for CKD. Urinary microalbumin-creatinine ratio (ACR) is one of the key predictors for CKD progression. While liver fibrosis can be assessed by vibration controlled transient elastography (VCTE), it can be simply calculated using Fibrosis-4 score (FIB-4) by Age × AST/[PLT × √ALT]. We aim to examine the association of liver fibrosis measured by FIB-4, stratified by DM status, with ACR and compare it with VCTE-ACR association.

Methods

A retrospective cross-sectional study using 2017-2020 NHANES data included participants with calculated FIB-4 and VCTE, stratified into low/high FIB-4 (≤ or >2.67) and significant fibrosis (VCTE< or ≥8 kPa). Up to 15% had DM. ACR was grouped as <30, 30-299, and ≥300 mg/g. Associations of FIB-4, VCTE, and DM with ACR were investigated by ordinal logistic regression adjusted by demographics, comorbidities, lab values, and socioeconomic status.

Results

Of 6,090 adults, mean age was 51±17 years and eGFR was 93±23 mL/min/1.73 m². The median [IQR] ACR was 7.5[4.8-14.9] mg/g. Median FIB-4 score and VCTE level were 0.93[0.61-1.38] and 5[4.1-6.3], respectively. In the fully adjusted model, high FIB-4, DM, and both combined were graded associated with greater odds of higher ACR group (aOR_FIB-4(95%CI) 1.83(1.18-2.83), P 0.007; aOR_DM 2.99(2.48-3.59), P<0.001; aOR_FIB-4+DM 5.12(2.85-9.18), P<0.001).
The direction of the VCTE-DM-ACR association showed a similar trend with higher magnitude except for the combined VCTE and DM (aOR_VCTE 2.05(1.63-2.57), P<0.001; aOR_DM 3.50(2.83-4.33), P<0.001; aOR_VCTE+DM 3.60(2.74-4.74), P<0.001).
While there was no effect modification for FIB-4-DM-ACR, DM was an effect modifier between VCTE-ACR with lower odds of worsening ACR seen in DM group (P_interaction<0.001).

Conclusion

The strong association between FIB-4 and worsening ACR, particularly in DM patients, compared to the VCTE-ACR highlights the utility of FIB-4, assessed with routine blood tests, in risk stratification in patients at increased risk of albuminuria and CKD progression.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.202546dn14ys