A study published in BMCMedicine finds that in people with chronic kidney disease, non-alcoholic fatty liver disease is associated with an increased risk of cardiovascular event and worse survival.
]. A small percentage may have developed cirrhotic cardiomyopathy. These pathophysiological changes manifest in CKD too, so there may be an interaction between NAFLD fibrosis and CKD which increases heart failure risk. As far as we are aware, we are the first group to demonstrate a relationship between NAFLD fibrosis with heart failure prospectively and the first to examine this in the context of CKD.
This is the largest cohort of CKD patients in which the impact of having NAFLD on multimorbid clinical outcomes and ACM has been examined and is the first prospective study in this field. Consequently, we were able to examine the influence of NAFLD and NAFLD fibrosis and identify that this is a key determinant of adverse clinical outcomes in this cohort.
UKBB participants did not however undergo baseline ultrasound to look for hepatic steatosis; thus, our definition of NAFLD was predominantly based on the HSI. This score is endorsed for population screening of NAFLD []; however, there is limited evidence indicating how it performs in patients with CKD.
]. If this limitation introduced bias into our study, it would have reduced the significance of the associations we observed. The low number of people with NAFLD defined using ICD codes precluded any meaningful analysis of this group on its own. This number is low as most patients with NAFLD are managed in the community, or an outpatient setting or have undetected disease.].
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