Hilmi Erdem Sumbul, Ali Kirik, Selcuk Yaylaci, Alihan Oral, Sibel Ocak Serin, Kubilay Issever, Nizameddin Koca, Ahmet Aydin, Ismail Demir, Nevzat Gozel, Pinar Yildiz, Oguzhan Sitki Dizdar, Enes Seyda Sahiner, Seyit Uyar, Emin Gemcioglu, Hasan Esat Yucel, Cem Sahin, Hasan Sozel, Osman Ozudogru, Gokhan Tazegul, Melisa Sahin Tekin, Emel Saglam, Begum Seyda Avci, Erdinc Gulumsek, Huseyin Ali Ozturk, Demet Yalcin Kehribar, Hasan Tunca, Elif Duygu Topan, Tuba Taslamacioglu Duman, Abdullah Tanrikulu, Hakan Sivgin, Hikmet Oztop, Muhammet Ozbilen, Necip Nas, Mehmet Selim Mamis, Ozge Kurtkulagi, Kamil Konur, Ismail Kirli, Fatih Kamis, Ozge Kama Basci, Ahmed Bilal Genc, Muzeyyen Eryilmaz, Betül Erismis, Yasin Sahinturk, Nur Duzen Oflas, Erkan Dulkadiroglu, Ayse Kevser Demir, Deniz Cekic, Erkan Cakmak, Hatice Beyazal Polat, Hilal Bektas Uysal, Turkan Pasali Kilit, Sibel Demiral Sezer, Emine Binnetoglu, Esref Arac, Ihsan Solmaz, Hacer Sen, Gulali Aktas, Burcin Meryem Atak Tel, Lale Saka Baraz, Bahri Abayli, Hale Akan, Canan Akkus, Berrin Aksakal, Sami Bahcebasi, Orhan Balikci, Muharrem Bayrak, Omer Faruk Alakus, Ifakat Irem Bicer, Rifat Bozkus, Bilgin Bahadir Basgoz, Fatih Coskun, Cuneyt Cagatay, Feride Caglar, Ulfet Deger, Ali Erol, Aysegul Ertinmaz, Melis Gokgoz, Fatih Ileri, Ugur Can Izlimek, Aynur Kamburoglu, Sanem Kayhan, Yusuf Kimyon, Seref Enes Kocaman, Celalettin Kucuk, Hatice Metin, Oktay Olmuscelik, Erkan Ozdemir, Ensar Ozmen, Hatice Ozge Serin, Ahmet Veli Sanibas, Ece Unal Cetin, Nazif Yalcin, Mehmet Serdar Yildirim, Hasan Esat Yildirim, Huseyin Yildiz, Oguzhan Zengin, Ali Zeynettin, Fatih Atik, Selin Muge Aslan, Nurcan Aslan, Sare Babacan Celikel, Suat Baran Bakan, Bektas Isik, Cisem Yilmaz, Ahmet Gazi Mustan, Cahit Dincer, Yagmur Sena Tosun, Rabia Ulutas, Tugce Nur Yazici, Emrah Yilmaz, Muhammed Rasit Altinisik, Bercem Berent, Hamit Yildiz, Ramazan Azim Okyay
Hepatic fibrosis severity, as quantified by the FIB-4 index, is independently associated with impaired kidney function in patients with MASLD beyond established cardiometabolic risk factors. These findings support the role of FIB-4 as a simple, cost-effective tool for integrated cardio-hepato-renal risk stratification. Clinicians should systematically monitor renal function in MASLD patients, particularly those with elevated FIB-4 scores.
BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a systemic metabolic disorder associated with extrahepatic organ damage, including chronic kidney disease (CKD). The Fibrosis-4 (FIB-4) index is a validated non-invasive tool for estimating hepatic fibrosis severity. This study aimed to investigate whether FIB-4-defined hepatic fibrosis is independently associated with reduced estimated glomerular filtration rate (eGFR) in a large, real-world Turkish MASLD cohort.
METHODS: This is a cross-sectional analysis of the prospective, nationwide, multicenter DAHUDER MASLD Study, which enrolled patients from 44 internal medicine outpatient clinics across 31 provinces representing all 12 statistical regions of Türkiye. A total of 10,873 MASLD patients were included. MASLD was defined as ultrasonographic hepatic steatosis in the presence of at least one cardiometabolic risk factor. High FIB-4 was defined as ≥ 1.3 for patients aged < 65 years and ≥ 2.0 for those aged ≥ 65 years, per EASL-EASD-EASO 2024 guidelines. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Age-stratified multivariate linear regression models were constructed to identify independent predictors of eGFR.
RESULTS: High FIB-4 was detected in 11.2% of the patients (n = 1219). Patients with high FIB-4 had significantly lower eGFR compared to those with low FIB-4 (85.37 ± 21.08 vs. 94.18 ± 20.17 mL/min/1.73 m2, p < 0.001). FIB-4 score was negatively correlated with eGFR (r = - 0.149, p < 0.001). In age-stratified multivariate analysis adjusted for diabetes mellitus, hypertension, BMI, sex, SGLT2 inhibitor use, and uric acid, FIB-4 score remained an independent predictor of reduced eGFR in both age groups (< 65 years: B = - 2.586, 95% CI [- 3.025, - 2.148], p < 0.001; ≥ 65 years: B = - 1.384, 95% CI [- 2.326, - 0.443], p = 0.004). eGFR decreased progressively across cardiometabolic risk score categories, from approximately 105 mL/min/1.73 m2 (score 1) to approximately 87 mL/min/1.73 m2 (score 5). KDIGO-based staging revealed a higher prevalence of advanced CKD stages in the high FIB-4 group (p < 0.001).
CONCLUSIONS: Hepatic fibrosis severity, as quantified by the FIB-4 index, is independently associated with impaired kidney function in patients with MASLD beyond established cardiometabolic risk factors. These findings support the role of FIB-4 as a simple, cost-effective tool for integrated cardio-hepato-renal risk stratification. Clinicians should systematically monitor renal function in MASLD patients, particularly those with elevated FIB-4 scores.