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Zhou R, Yang L, Zhang B, Gu Y, Kong T, Zhang W, Sun L, Liu C, Kong N, Li J, Shi J. Clinical impact of hepatic steatosis on chronic hepatitis B patients in Asia: A systematic review and meta-analysis. J Viral Hepat 2023; 30:793-802. [PMID: 37533208 DOI: 10.1111/jvh.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
Chronic hepatitis B (CHB) and hepatic steatosis (HS) are two prevalent chronic liver diseases in Asia. The incidence of CHB combined with HS is increasing due to the rising obesity rates. However, the impact of HS on CHB remains a topic of debate. Hereby, this meta-analysis aims to examine the effect of HS on Asian patients with CHB. Searches were conducted on four databases to identify articles published from 2005 to 2023. The random-effects or fixed-effects model was used to calculate pooled odds ratios (ORs), weighted mean difference (WMD), and confidence intervals (CIs) for the included articles. Of the 15,959 records screened, 88 studies were included in the analysis of HS prevalence in Asian CHB patients with a prevalence of 36.5% (95% CI: 33.7%-39.3%). In addition, age, sex, body mass index (BMI), waist circumference (WC), alanine aminotransferase (ALT) and combined metabolic diseases have varying degrees of impact on HS in CHB patients. Furthermore, the coexistence of HS was negatively associated with the response to antiviral therapy, including hepatitis B surface antigen (HBeAg) seroconversion (OR = 0.69, 95% CI: 0.53-0.89) and ALT normalization (OR = 0.75, 95% CI: 0.61-0.92) in CHB patients after 48 weeks of treatment. Regarding disease prognosis, HS was not significantly associated with fibrosis or cirrhosis in CHB patients, while an inverse association was observed between HS and hepatocellular carcinoma (HCC) (OR = 2.93, 95% CI: 1.23-6.99). This implies that the coexistence of HS in CHB patients may exacerbate the progression of HCC, which needs to be verified by further studies.
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Affiliation(s)
- Run Zhou
- College of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Luping Yang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Binbin Zhang
- The Department of Translational Medicine Platform, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Department of School of Life Sciences, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Yunpeng Gu
- School of Nursing, Henan University of Chinese Medicine, Zhengzhou, China
| | - Tingting Kong
- College of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Wei Zhang
- Department of Teaching, Hangzhou Normal University, Hangzhou, China
| | - Lei Sun
- College of Clinical Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Chunlan Liu
- College of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Ningjia Kong
- College of Clinical Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jie Li
- Department of Infectious Disease, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Junping Shi
- College of Clinical Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- The Department of Infectious disease and Hepatology, The Affiliated Hospital & Institute of Hepatology and Metabolic Disease, Hangzhou Normal University, Hangzhou, China
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Wong WK, Chan WK, Ganapathy SS, Lim SK. Metabolic dysfunction-associated fatty liver disease (MAFLD) and advanced liver fibrosis among hemodialysis patients in a multiethnic urban population in Malaysia. Semin Dial 2023; 36:107-116. [PMID: 35821201 DOI: 10.1111/sdi.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Metabolic-dysfunction-associated fatty liver disease (MAFLD) and end stage kidney disease (ESKD) are complications of the metabolic syndrome. Our aim is to study the prevalence of MAFLD and advanced liver fibrosis and the associated factors among hemodialysis patients in a multiracial urban population in Malaysia. METHODS A cross-sectional study of hemodialysis patients from 10 hemodialysis centers was used. FibroTouch examination was performed on all patients. Fatty liver was diagnosed based on ultrasound attenuation parameter ≥248 dB/m while advanced liver fibrosis was diagnosed based on liver stiffness measurement ≥10 kPa. RESULTS This study included 447 hemodialysis patients (median age 59 [50-67], male 55%, Chinese 61%, Malay 20%, Indian 18%). Dialysis vintage was 49 (22-93) months. The prevalence of MAFLD was 43.4%. Independent factors associated with MAFLD were elevated waist circumference (aOR = 10.1, 95% CI = 5.3-19.4, p < 0.001), normal platelet count (aOR = 3.1, 95% CI = 1.3-7.3, p < 0.05), low HDL cholesterol (aOR = 2.3, 95% CI = 1.3-4.2, p < 0.01), elevated fasting blood sugar (aOR = 2.3, 95% CI = 1.3-3.8, p < 0.01), elevated hsCRP (aOR = 2.2, 95% CI = 1.2-4.0, p < 0.01), and advanced liver fibrosis (aOR = 3.0, 95% CI = 1.6-5.6, p < 0.001). The prevalence of advanced liver fibrosis was 25.5%. Independent factors associated with advanced liver fibrosis were male gender (aOR = 1.8, 95% CI = 1.0-3.0, p < 0.05), elevated waist circumference (aOR = 2.0, 95% CI = 1.0-4.0, p < 0.05), low platelet count (aOR = 5.4, 95% CI = 2.7-11.0, p < 0.001), elevated GGT (aOR = 5.0, 95% CI = 2.9-8.8, p < 0.001), and MAFLD (aOR = 3.2, 95% CI = 1.7-5.9, p < 0.001). CONCLUSION A high prevalence of MAFLD and advanced liver fibrosis was observed among hemodialysis patients. Nephrologists should consider a more proactive approach in diagnosing MAFLD and/or advanced liver fibrosis in hemodialysis patients.
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Affiliation(s)
- Wei-Kei Wong
- Department of Medicine, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Soo-Kun Lim
- Nephrology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Niepolski L, Drzewiecka H, Warchoł W. Circulating vascular endothelial growth factor receptor 2 levels and their association with lipid abnormalities in patients on hemodialysis. Biomed Rep 2021; 14:37. [PMID: 33692900 PMCID: PMC7938296 DOI: 10.3892/br.2021.1413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to examine the association between the levels of circulating vascular endothelial growth factor receptor (VEGFR)2 levels, serum lipid composition and plasma receptor for advanced glycation end-products (RAGE) expression in patients undergoing hemodialysis (HD). A total of 50 patients on HD (27 men and 23 women; median age, 66 years; age range 28-88 years; HD mean time, 29.0, 3.9-157.0 months) were enrolled. Age-matched healthy subjects (n=26) were used as the control group. Plasma VEGFR2 and RAGE levels were determined using ELISA. Dyslipidemia (D) in patients on HD was diagnosed according to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease. Circulating VEGFR2, RAGE and serum lipids were compared between dyslipidemic and non-dyslipidemic patients on HD and controls. In patients on HD, the plasma VEGFR2 levels were lower compared with those in the healthy population. D was associated with high plasma VEGFR2 levels. The triglyceride/HDL-cholesterol ratio was strongly associated with plasma VEGFR2 levels. The plasma VEGFR2 concentration was associated with circulating RAGE levels. Therefore, circulating VEGFR2 levels may be partly associated with lipid abnormalities and plasma RAGE levels in patients receiving HD.
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Affiliation(s)
- Leszek Niepolski
- Department of Physiology, Poznan University of Medical Sciences, Poznań 60-781, Poland
| | - Hanna Drzewiecka
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznań 60-781, Poland
| | - Wojciech Warchoł
- Department of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznań 60-781, Poland
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Veracruz N, Hameed B, Saab S, Wong RJ. The Association Between Nonalcoholic Fatty Liver Disease and Risk of Cardiovascular Disease, Stroke, and Extrahepatic Cancers. J Clin Exp Hepatol 2021; 11:45-81. [PMID: 33679048 PMCID: PMC7897860 DOI: 10.1016/j.jceh.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Although primarily a disease with liver-specific complications, nonalcoholic fatty liver disease (NAFLD) is a systemic disease with extrahepatic complications. We aim to evaluate the association between NAFLD and cardiovascular disease (CVD), stroke and cerebrovascular disease, and extrahepatic cancers. METHODS We searched MEDLINE, EMBASE, and Cochrane Systematic Review Database from January 1, 2000 to July 1, 2019 to identify peer-reviewed English language literature using predefined keywords for NAFLD, CVD, stroke and cerebrovascular disease, and extrahepatic cancers among adults. Two reviewers independently selected studies for inclusion. Measures of association between NAFLD and CVD, stroke and cerebrovascular disease, and extrahepatic cancers were extracted. Quality assessed using Newcastle-Ottawa scale and Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Thirty studies were included evaluating CVD, 16 studies evaluating stroke or cerebrovascular disease, and 13 studies evaluating extrahepatic cancers. On pooled meta-analysis assessment, NAFLD was associated with increased risk of CVD (risk ratio [RR]: 1.78; 95% confidence interval [CI]: 1.52-2.08) and stroke or cerebrovascular disease (RR: 2.08, 95% CI: 1.72-2.51). Significant heterogeneity in assessing extrahepatic cancers prevented applying meta-analysis methods, but NAFLD seemed to be associated with increased risk of breast and colorectal cancers. Overall level of quality of studies were very low by GRADE. CONCLUSIONS NAFLD is associated with increased risks of CVD and stroke or cerebrovascular disease among adults. There appears to be increased risk of breast and colorectal cancers. Given low quality of evidence, it is premature to make any strong conclusions to modify CVD, stroke, or cancer screening policies in patients with NAFLD.
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Affiliation(s)
- Nicolette Veracruz
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Bilal Hameed
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Sammy Saab
- Division of Gastroenterology and Hepatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA
- Address for correspondence:
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Hydes T, Buchanan R, Kennedy OJ, Fraser S, Parkes J, Roderick P. Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease. BMJ Open 2020; 10:e040970. [PMID: 32988952 PMCID: PMC7523199 DOI: 10.1136/bmjopen-2020-040970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To investigate if non-alcoholic fatty liver disease (NAFLD) impacts mortality and adverse outcomes for individuals with chronic kidney disease (CKD). DESIGN Systematic review. DATA SOURCES PubMed, EMBASE and Web of Science were searched up to 1 February 2020 with no restriction on the earliest date. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational cohort studies that reported either the risk of all-cause mortality, incidence of non-fatal cardiovascular events (CVE) or progression of kidney disease among adults with established CKD who have NAFLD compared with those without. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed bias independently. RESULTS Of 2604 records identified, 3 studies were included (UK (n=852), South Korea (n=1525) and USA (n=1413)). All were judged to have a low or moderate risk of bias. Data were insufficient for meta-analysis. Two studies examined the influence of NAFLD on all-cause mortality. One reported a significant positive association for NAFLD with all-cause mortality for individuals with CKD (p<0.05) (cardiovascular-related mortality p=ns), which was lost following adjustment for metabolic risk factors; the second reported no effect in adjusted and unadjusted models. The latter was the only study to report outcomes for non-fatal CVEs and observed NAFLD to be an independent risk factor for this (propensity-matched HR=2.00, p=0.02). Two studies examined CKD progression; in one adjusted rate of percentage decline in estimated glomerular filtration rate per year was found to be increased in those with NAFLD (p=0.002), whereas the other found no significant difference. CONCLUSIONS Few studies have examined the influence of NAFLD on prognosis and major adverse clinical outcomes within the CKD population. The studies identified were diverse in design and results were conflicting. This should be a focus for future research as both conditions continue to rise in prevalence and have end-stage events associated with significant health and economic costs. PROSPERO REGISTRATION NUMBER CRD42020166508.
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Affiliation(s)
- Theresa Hydes
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ryan Buchanan
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Oliver J Kennedy
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon Fraser
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Roderick
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Wu PJ, Chen JB, Lee WC, Ng HY, Lien SC, Tsai PY, Wu CH, Lee CT, Chiou TTY. Oxidative Stress and Nonalcoholic Fatty Liver Disease in Hemodialysis Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3961748. [PMID: 30515395 PMCID: PMC6236669 DOI: 10.1155/2018/3961748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/14/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is becoming more common around the world and it may progress to cirrhosis and liver failure, increasing mortality risk. In hemodialysis (HD) patients, NAFLD may be a novel risk factor for their high cardiovascular mortality. Heightened oxidative stress is highly prevalent in HD patients. However, the relationship between oxidative stress and NAFLD in HD patients is not well defined. METHODS We studied seventy-one stable nondiabetic HD patients. Nineteen patients had the diagnosis of NAFLD by ultrasonography. Blood levels of oxidative stress markers were measured in each patient, including thiobarbituric acid reactive substances (TBARS), free thiols, superoxide dismutase (SOD) activities, and glutathione peroxidase (GPx) activity. The copy numbers of mitochondrial DNA (mtDNA) in peripheral leukocytes were also determined. Demographic, biochemistry, and hemogram data were recorded. The two groups of patients were compared in order to determine the factors associated with NAFLD in HD patients. FINDINGS Compared to those without NAFLD, nondiabetic HD patients with NAFLD had significantly higher mtDNA copy number and GPx levels. The two groups did not differ significantly in dialysis adequacy, hemoglobin, serum calcium, phosphorus, albumin, liver function tests, or lipid profiles. Regression analysis confirmed mtDNA copy numbers and GPx levels as two independent factors associated with NAFLD. Compared to those with polysulfone, patients dialyzed with cellulose membrane have significantly higher levels of TBARS. However, patients with or without NAFLD did not differ in their use of either dialysis membrane. DISCUSSION Oxidative stress (represented by antioxidant defense, GPx) and mitochondrial DNA copy numbers are independently associated with fatty liver disease in nondiabetic HD patients. The diagnostic and therapeutic implications of this key observation warrant further exploration.
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Affiliation(s)
- Po-Jung Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Hwee-Yeong Ng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Shu-Ching Lien
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Pei-Ying Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
| | - Terry Ting-Yu Chiou
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine and Chung Shan Medical University School of Medicine, Taiwan
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Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study. PLoS One 2017; 12:e0176027. [PMID: 28426815 PMCID: PMC5398606 DOI: 10.1371/journal.pone.0176027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIMS Controlled attenuation parameter (CAP) is a non-invasive method for measuring hepatic steatosis (HS). Non-alcoholic fatty liver disease (NAFLD) is closely related to cardiovascular diseases (CVDs). CVDs are the leading cause of morbidity and mortality in hemodialysis patients. The aim of this study was to investigate the prevalence of NAFLD in hemodialysis patients. METHOD We prospectively enrolled patients undergoing chronic hemodialysis, as well as patients with normal renal function who served as controls. The control group patients were referred by an endocrinologist to be tested for NAFLD; most of these patients had diabetes, hypertension, or dyslipidemia. We excluded those with excess alcohol intake, use of drugs known to induce HS, chronic viral hepatitis, or CAP failure. CAP ≥ 238 dB/m was used as a cutoff suggesting HS. An increased liver kidney contrast, as defined by ultrasound, was used to make the diagnosis of HS. RESULTS Three hundred and forty-three hemodialysis patients and 252 control group patients were enrolled. Among the hemodialysis patients, 192 (56.0%) had CAP- or ultrasound-identified HS compared with 91 (26.5%) who only had ultrasound-identified HS (P<0.001). Among the control group patients, 212 (84.1%) had CAP- or ultrasound-identified HS compared with 180 (71.4%) who only had ultrasound-identified HS (P<0.001). CONCLUSIONS The prevalence of NAFLD in the hemodialysis patients was 56%. The number of diagnoses of NAFLD made by using CAP combined with ultrasound was more than 2 times the number made with ultrasound alone in the hemodialysis patients. Therefore, we suggest the use of CAP combined with ultrasound to screen for NAFLD in hemodialysis patients.
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Mikolasevic I, Orlic L, Poropat G, Jakopcic I, Stimac D, Klanac A, Carovic F, Milic S. Nonalcoholic fatty liver and the severity of acute pancreatitis. Eur J Intern Med 2017; 38:73-78. [PMID: 27825671 DOI: 10.1016/j.ejim.2016.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022]
Abstract
AIM To explore the effect of nonalcoholic fatty liver as a hepatic manifestation of metabolic syndrome on the severity of acute pancreatitis. We hypothesized that patients with nonalcoholic fatty liver would have a more severe form of acute pancreatitis. PATIENTS AND METHODS We retrospectively analyzed 822 patients hospitalized with acute pancreatitis. We diagnosed acute pancreatitis and determined its severity according the revised Atlanta classification criteria from 2012. We assessed nonalcoholic fatty liver with computed tomography. RESULTS There were 198 (24.1%) patients out of 822 analyzed who had nonalcoholic fatty liver. Patients with nonalcoholic fatty liver had statistically higher incidence of moderately severe (35.4% vs. 14.6%; p=0.02) and severe acute pancreatitis (20.7% vs. 9.6%; p<0.001) compared to patients without nonalcoholic fatty liver. At the admission patients with nonalcoholic fatty liver had higher values of C-reactive protein as well as at day three, higher APACHE II score at admission and significantly higher incidence of organ failure and local complications as well as higher values of computed tomography severity index compared to patients without nonalcoholic fatty liver. We found independent association between the occurrence of moderately severe and severe acute pancreatitis and nonalcoholic fatty liver (OR 2.13, 95%CI 1.236-3.689). Compared to patients without nonalcoholic fatty liver, patients with nonalcoholic fatty liver had a higher death rate, however not statistically significant (5.6% vs. 4.3%; p=NS). CONCLUSION Presence of nonalcoholic fatty liver at admission can indicate a higher risk for developing more severe forms of acute pancreatitis and could be used as an additional prognostic tool.
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Affiliation(s)
- I Mikolasevic
- Department of Gastroenterology, UHC Rijeka, Croatia.
| | - L Orlic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia
| | - G Poropat
- Department of Gastroenterology, UHC Rijeka, Croatia
| | | | - D Stimac
- Department of Gastroenterology, UHC Rijeka, Croatia
| | - A Klanac
- School of Medicine, Rijeka, Croatia
| | | | - S Milic
- Department of Gastroenterology, UHC Rijeka, Croatia
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Mikolasevic I, Milic S, Racki S, Zaputovic L, Stimac D, Radic M, Markic D, Orlic L. Nonalcoholic Fatty Liver Disease (NAFLD)-A New Cardiovascular Risk Factor in Peritoneal Dialysis Patients. Perit Dial Int 2015; 36:427-32. [PMID: 26475841 DOI: 10.3747/pdi.2014.00223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 07/23/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND Recent investigations indicated that nonalcoholic fatty liver disease (NAFLD), a hepatic component of metabolic syndrome (MS), is associated with an increased risk of cardiovascular disease (CVD). Accordingly, we were interested in exploring the frequency of NAFLD in peritoneal dialysis (PD) patients and analyzing factors in PD patients associated with NAFLD occurrence. In addition, we were interested in investigating whether NAFLD is associated with higher CVD risk in our PD patients. ♦ METHODS In the present cross-sectional study, we analyzed 58 PD patients. The controlled attenuation parameter (CAP) was used to detect and quantify liver steatosis with the help of transient elastography (TE) (FibroScan, Echosense SA, Paris, France). A carotid ultrasound was performed in all patients to measure carotid intimae media thickness (IMT) and plaque as surrogate measures of increased CVD risk, and we investigated their association with NAFLD. ♦ RESULTS Nonalcoholic fatty liver disease was present in 74.1% of PD patients. Peritoneal dialysis/nonalcoholic fatty liver disease patients had statistically greater daily (136.5 ± 62.6 vs 93.6 ± 36.1; p = 0.02) and monthly (4,095.3 ± 1,877.7 vs 2,806.6 ± 1,083.2; p = 0.02) glucose load in comparison to the non-NAFLD/PD patients. In the next step, we were interested in analyzing what demographic and clinical characteristics in our PD patients are associated with a higher NAFLD occurrence. Presence of diabetes mellitus (DM), arterial hypertension (AH), dyslipidemia, body mass index > 25 kg/m(2), and daily glucose load > 100 g were associated with NAFLD occurrence. Peritoneal dialysis patients with NAFLD showed more carotid atherosclerosis than PD patients without NAFLD. In addition, CAP values (as indicator of liver steatosis) showed strong positive association with IMT (r = 0.801; p < 0.0001). Nonalcoholic fatty liver disease was a strong predictor of carotid atherosclerosis in PD patients. ♦ CONCLUSION Nonalcoholic fatty liver disease is highly prevalent in PD patients. Peritoneal dialysis patients with NAFLD are at high risk of atherosclerosis. Assessment of NAFLD in PD patients may be helpful for CVD risk stratification.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia Department of Gastroenterology, UHC Rijeka, Croatia
| | - Sandra Milic
- Department of Gastroenterology, UHC Rijeka, Croatia
| | - Sanjin Racki
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia
| | | | - Davor Stimac
- Department of Gastroenterology, UHC Rijeka, Croatia
| | - Mladen Radic
- Department of Gastroenterology, UHC Rijeka, Croatia
| | | | - Lidija Orlic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia
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Athyros VG, Tziomalos K, Katsiki N, Doumas M, Karagiannis A, Mikhailidis DP. Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease: An update. World J Gastroenterol 2015; 21:6820-6834. [PMID: 26078558 PMCID: PMC4462722 DOI: 10.3748/wjg.v21.i22.6820] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/31/2015] [Accepted: 05/07/2015] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is considered to be an independent cardiovascular disease (CVD) risk factor. However, simple steatosis has a benign clinical course without excess mortality. In contrast, the advanced form of NAFLD, non-alcoholic steatohepatitis (NASH) with liver fibrosis increases mortality by approximately 70%, due to an increase in CVD mortality by approximately 300%. Chronic kidney disease (CKD) may be caused by NAFLD/NASH and it substantially increases CVD risk, especially in the presence of type 2 diabetes mellitus. Moreover, CKD may trigger NAFLD/NASH deterioration in a vicious cycle. NAFLD/NASH is also related to increased arterial stiffness (AS), an independent CVD risk factor that further raises CVD risk. Diagnosis of advanced liver fibrosis (mainly by simple non-invasive tests), CKD, and increased AS should be made early in the course of NAFLD and treated appropriately. Lifestyle measures and statin treatment may help resolve NAFLD/NASH and beneficially affect the CVD risk factors mentioned above.
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Mikolasevic I, Stimac D, Racki S, Zaputovic L, Devcic B, Jelic I, Lukenda V, Radic M, Orlic L. Relationship between non-alcoholic fatty liver disease and MIA syndrome. Hemodial Int 2015; 19:472-81. [PMID: 25688578 DOI: 10.1111/hdi.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an important factor in the pathogenesis of cardiovascular diseases in the general population. Recently, it has been shown that NAFLD is highly prevalent in chronic kidney disease (CKD) patients. Ninety-four hemodialysis (HD) patients were followed for a time period of 18 months or until death. Patient's survival rate was determined in relation to their nutritional and inflammatory state, and the presence of NAFLD. We also investigated the association between the presence of NAFLD and the patients' nutritional and inflammatory state. We did not find any significant association between the clinical parameters of nutritional status and the mortality rate. However, the mortality rate was statistically significantly higher in patients with low serum albumin and high high-sensitive C-reactive protein (hs-CRP) levels and in those who had NAFLD. Surprisingly, patients who had received enteral nutrition did not have a better survival rate. The severity of liver steatosis was negatively correlated with the serum albumin levels, while it was positively correlated with hs-CRP values. Furthermore, serum albumin levels showed a negative correlation with hs-CRP levels. We did not find any significant association between the presence of NAFLD and clinical parameters of nutrition. We have shown that NAFLD could be one more possible example of reverse epidemiology in patients undergoing HD. NAFLD may be the missing link that causally ties malnutrition, inflammation, and atherosclerosis syndrome to the morbidity and mortality in patients undergoing HD.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Sanjin Racki
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
| | - Luka Zaputovic
- Department of Cardiology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Bosiljka Devcic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
| | - Ita Jelic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
| | - Vesna Lukenda
- Department of Internal Medicine, General Hospital "Dr. Josip Bencevic", Slavonski Brod, Croatia
| | - Mladen Radic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Lidija Orlic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
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