Wei Kei WONG1, Soo Kun LIM1, Shubash GANAPATHY2, Wah Kheong CHAN1

1Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia, 2National Institutes of Health, Ministry of Health, Malaysia

Background/Aims: Metabolic-dysfunction-associated fatty liver disease (MAFLD) and end stage kidney disease (ESKD) are complications of the metabolic syndrome.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. FibroTouch examination was performed on all patients. Fatty liver was diagnosed based on ultrasound attenuated 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 Malay (aOR 2.113, 95%CI 1.077-4.148, p=0.030) compared to Chinese, elevated waist circumference (aOR 9.798, 95% CI 5.066-18.950, p=<0.001), normal platelet count (aOR 3.163, 95%CI 1.309-7.641, p=0.011), elevated creatinine (aOR1.777, 95%CI 1.042-3.030, p=0.035), low HDL (aOR 2.207, 95% CI 1.201-4.058, p=0.011), elevated fasting sugar (aOR 2.321, 95% CI 1.324-4.070, p=0.003), elevated HbA1c (aOR 1.968, 95% CI 1.039-3.729, p=0.038), elevated hsCRP (aOR=2.102, 95%CI 1.166-3.790, p=0.013) and advanced liver fibrosis (aOR 3.218, 95% CI 1.709-6.056, p=<0.001). The prevalence of advanced liver fibrosis was 25.5%. Independent factors associated with advanced liver fibrosis were male gender (aOR 2.133, 95% CI 1.227-3.709, p=0.007), elevated waist circumference (aOR 2.216, 95%CI 1.101-4.461, p=0.026), low platelet count (aOR 5.708, 95%CI 2.783-11.709, p=<0.001), elevated GGT (aOR 5.116, 95%CI: 2.924-8.951, p=<0.001), low creatinine (aOR 2.003, 95% CI 1.174-3.416, p=0.011) and MAFLD (aOR 3.280, 95%CI: 1.744-6.169, 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.

Keywords: Fatty liver, Advanced liver fibrosis, Prevalence, Hemodialysis, Malaysia