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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

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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.

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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
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  2. Lidija Orlic
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Correspondence to Ivana Mikolasevic MD PhD.

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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

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