Skip to main content
SpringerLink
Log in

Usefulness of liver test and controlled attenuation parameter in detection of nonalcoholic fatty liver disease in patients with chronic renal failure and coronary heart disease

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

In recent years, nonalcoholic fatty liver disease (NAFLD) was recognized as an important factor in chronic kidney disease (CKD) pathogenesis. The concentrations of serum aminotransferases in both chronic dialysis and chronic renal failure (CRF) patients most commonly fall within the lower end of the range of normal values. The aim of the present study was to investigate the usefulness of four liver tests and four biological scores in detection of NAFLD in comparison with transient elastography (TE) findings in different groups of patients.

Methods

The study was cross-sectional analysis collected data from a single tertiary care center. Of 202 patents there were 52 patients with CKD, 50 patients with end-stage renal disease (ESRD) treated with haemodialysis (HD), 50 renal transplant recipients (RTRs) and 50 patients with proven coronary heart disease (CHD). Fifty sex- and age-matched individuals without NAFLD and with normal liver and kidney function tests served as controls. With the help of TE (FibroScan®, Echosense SA, Paris, France), liver stiffness was selected as the parameter to quantify liver fibrosis and Controlled Attenuation Parameter (CAP) was used to detect and quantify liver steatosis.

Results

According to the CAP findings 76.9 %CKD patients, 82 %HD patients, 74 %RTRs and 69.1 % CHD patients had CAP > 238 dB.m−1 and thus by definition NAFLD. We have found that ALT, AST and GGT levels were positively correlated with CAP values while ALT and AST showed positive correlation with liver stiffness acquired with TE only in CHD patients. According to TE findings APRI (AUC 0.796) and FIB-4 (AUC 0.790) scores were correlated with the presence of fibrosis, while HIS score was correlated with the presence of steatosis (AUC 0.867) only in CHD patients.

Conclusion

Liver tests and biological scores are not useful for NAFLD detection in CRF patients. TE with CAP provides the opportunity of noninvasive screening for NAFLD as well as liver fibrosis in patients with CRF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dowman JK, Tomlinson JW, Newsome N. Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2011;33:525–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Mikolasevic I, Racki S, Zaputovic l, Lukenda V, Milic S, Orlic L. Nonalcoholic fatty liver disease (NAFLD); a new risk factor for adverse cardiovascular events in dialysis patients. Med Hypotheses. 2014;82:205–8.

    Article  CAS  PubMed  Google Scholar 

  3. Mikolasevic I, Racki S, Lukenda V, Pavletic-Persic M, Milic S, Orlic L. Non-alcoholic fatty liver disease; a part of the metabolic syndrome in the renal transplant recipient and possible cause of an allograft dysfunction. Med Hypotheses. 2014;82:36–9.

    Article  CAS  PubMed  Google Scholar 

  4. Targher G, Arcaro G. Non-alcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis. 2007;191:235–40.

    Article  CAS  PubMed  Google Scholar 

  5. Farrel GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99–S112.

    Article  Google Scholar 

  6. Musso G, Gambino R, Tabibian JH, et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med. 2014;11(7):e1001680.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Targher G, Bertolini L, Rodella S, Lippi G, Zoppini G, Chonchol M. Relationship between kidney function and liver histology in subjects with nonalcoholic steatohepatitis. Clin J Am Soc Nephrol. 2010;5:2166–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Hamad AA, Khalil AA, Connolly V, Ahmed MH. Relationship between non-alcoholic fatty liver disease and kidney function: a communication between two organs that needs further exploration. Arab J Gastroenterol. 2012;13:161–5.

    Article  CAS  PubMed  Google Scholar 

  9. Mikolasevic I, Racki S, Bubic I, Jelic I, Stimac D, Orlic L. Chronic kidney disease and nonalcoholic fatty liver disease proven by transient elastography. Kidney Blood Press Res. 2013;37:305–10.

    Article  CAS  PubMed  Google Scholar 

  10. Martinez SM, Crespo G, Navasa M, Forns X. Noninvasive assessment of liver fibrosis. Hepatology. 2011;53:325–35.

    Article  PubMed  Google Scholar 

  11. Sasso M, Beaugrand M, de Ledinghen V, Douvin C, Marcellin P, Poupon R, et al. Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36(11):1825–35.

    Article  PubMed  Google Scholar 

  12. Wong Lai-Hung G. Update of liver fibrosis and steatosis with transiet elastography (Fibroscan®). Gastroenterol Rep. 2013;1(1):19–26. doi:10.1093/gastro/got007.

    Article  Google Scholar 

  13. de Lédinghen V Vergniol J Foucher J Merrouche W le Bail B. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32:911–8.

    Article  PubMed  Google Scholar 

  14. Karlas T, Petroff D, Garnov N, Böhm S, Tenckhoff H, Wittekind C, et al. Non-invasive assessment of hepatic steatosis in patients with NAFLD using controlled attenuation parameter and 1H-MR spectroscopy. PLoS One. 2014;9:e91987.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Liberato IR, Lopes EP, Cavalcante MA, Pinto TC, Moura IF, Loureiro Júnior L. Liver enzymes in patients with chronic kidney disease undergoing peritoneal dialysis and hemodialysis. Clinics. 2012;67(2)131–4.

    Article  PubMed  Google Scholar 

  16. Ono K, Ono T, Matsumata T. The pathogenesis of decreased aspartate amino-transferase and alanine aminotransferase activity in the plasma of hemodialysis patients: the role of vitamin B6 deficiency. Clin Nephrol.1995;43:405–8.

    CAS  PubMed  Google Scholar 

  17. Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotrasnferase levels. Ann Int Med. 2002;137:1–9.

    Article  CAS  PubMed  Google Scholar 

  18. Villanova N, Moscatiello S, Ramilli S, Bugianesi E, Magalotti D, Vanni E, et al. Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease. Hepatology. 2005;42:473–80.

    Article  PubMed  Google Scholar 

  19. Targher G, Mantovani A, Pichiri I, Mingolla L, Cavalieri V, Mantovani W, et al. Nonalcoholic fatty liver disease is independently associated with an increased incidence of chronic kidney disease in patients with type 1 diabetes. Diabetes Care. 2014;37:1729–36.

    Article  CAS  PubMed  Google Scholar 

  20. Locatelli F, Pozzoni P, Tentori F, del Vecchio L. Epidemiology of cardiovascular risk in patients with chronic kidney disease. Nephrol Dial Transplant. 2003;18(Suppl 7):vii2–9.

    Article  PubMed  Google Scholar 

  21. Cuevas X, García F, Martín-Malo A, Fort J, Lladós F, Lozano J, et al. Risk factor associated with cardiovascular morbidity and mortality in Spanish incident hemodialysis patients: two-year results from ANSWER study. Blood Purif. 2012;33:21–9.

    Article  PubMed  Google Scholar 

  22. Vanholder R, Massy Z, Argiles A, Spasovski G, Verbeke F, Lameire N, European Uremic Toxin Work Group. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant. 2005;20:1048–56.

    Article  CAS  PubMed  Google Scholar 

  23. Hricik D. Metabolic syndrome in kidney transplantation: management of risk factors. Clin J Am Soc Nephrol. 2011;6:1781–5.

    Article  PubMed  Google Scholar 

  24. Jardine AG, Gaston RS, Fellstrom BC, Holdaas H. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet. 2011;378:1419–27.

    Article  PubMed  Google Scholar 

  25. Mikolasevic I, Jelic I, Sladoje-Martinovic B, Orlic L, Zivcic-Cosic S, Vuksanovic-Mikulicic S, et al. Metabolic disorders in renal transplant recipients. Acta Med Croatica. 2012;66:235–41.

    CAS  PubMed  Google Scholar 

  26. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993;118:96–98.

    Article  CAS  PubMed  Google Scholar 

  27. Berziggoti A. Getting closer to a point-of-care diagnostic assessment in patients with chronic liver disease: Controlled attenuation parameter for steatosis. J Hepatol 2014;60:910–2.

    Article  Google Scholar 

  28. de Lédinghen V, Vergniol J, Capdepont M, Chermark F, Hiriart JB, Cassinotto C, et al. Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol 2014;60:1026–31.

    Article  PubMed  Google Scholar 

  29. Yilmaz Y, Ergelen R, Akin H, Imeryuz N. Noninvasive detection of hepatic steatosis in patients without ultrasonographic evidence of fatty liver using the controlled attenuation parameter evaluated with transient elastography. Eur J Gastroenterol Hepatol. 2013;25:1330–4.

    Article  PubMed  Google Scholar 

  30. Masaki K, Takaki S, Hyogo H, Kobayashi T, Fukuhara T, Naeshiro N, et al. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver diseases. Hepatol Res. 2013. http://dx.doi.org/10.1111/hepr.12094 [Epub ahead of print].

  31. Chon YE, Jung KS, Kim SU, Park JY, Park YN, Kim DY, et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver Int 2014;34:102–9.

    Article  PubMed  Google Scholar 

  32. Chan WK, Nik Mustapha NR, Mahadeva S. Controlled attenuation parameter for the detection and quantification of hepatic steatosis in nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2014;29:1470–6.

    Article  CAS  PubMed  Google Scholar 

  33. Mi YQ, Shi QY, Xu L, Shi RF, Liu YG, Li P, Shen F, Lu W, Fan JG. Controlled attenuation parameter for noninvasive assessment of hepatic steatosis using fibroscan(®): validation in chronic hepatitis B. Dig Dis Sci. 2015;60:243–51.

    Article  CAS  PubMed  Google Scholar 

  34. Yilmaz Y, Yesil A, Gerin F, Ergelen R, Akin H, Celikel ÇA, Imeryuz N. Detection of hepatic steatosis using the controlled attenuation parameter: a comparative study with liver biopsy. Scand J Gastroenterol. 2014;49:611–6.

    Article  PubMed  Google Scholar 

  35. Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis 2010;42:503–8.

    Article  CAS  PubMed  Google Scholar 

  36. Machado MV, Cortez-Pinto H. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. J Hepatol 2013;58:1007–19.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Rijeka, Croatia

    Ivana Mikolasevic MD PhD, Lidija Orlic, Sanjin Racki & Bosiljka Devcic

  2. Department of Cardiology, UHC Rijeka, Rijeka, Croatia

    Luka Zaputovic & Zlatko Cubranic

  3. Infectious Disease Clinic, UHC Osijek, Osijek, Croatia

    Kata Anic

  4. Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia

    Davor Stimac

Authors
  1. Ivana Mikolasevic MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lidija Orlic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luka Zaputovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjin Racki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zlatko Cubranic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kata Anic
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bosiljka Devcic
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Davor Stimac
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivana Mikolasevic MD PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mikolasevic, I., Orlic, L., Zaputovic, L. et al. Usefulness of liver test and controlled attenuation parameter in detection of nonalcoholic fatty liver disease in patients with chronic renal failure and coronary heart disease. Wien Klin Wochenschr 127, 451–458 (2015). https://doi.org/10.1007/s00508-015-0757-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-015-0757-z

Keywords

Search

Navigation