Detection of Metabolically Dysfunctional-Associated Steatotic Liver Disease with FIB4 in End-Stage Renal Disease

Introduction and aim: Liver disease is associated with obesity, diabetes, and steatotic liver, aside from viral causes and alcohol consumption. Likewise, chronic kidney disease shares metabolic risk factors and a viral etiology with liver disease, contributing to its development and accelerated progression. The clinical data for both pathologies is very similar, which makes early identification of liver damage difficult when they overlap. The aim of this study was to identify chronic liver disease using the fibrosis-4 index (FIB4) in end-stage renal disease undergoing hemodialysis patients, also describing etiology and biochemical variables. Patients and Methods: The study was realized at a secondary-level referral hospital for hemodialysis of the Mexican Social Security Institute in Northeast Mexico. Results: All patients with end-stage renal disease undergoing hemodialysis between 2017 and 2019 were included. Of the 362 patients evaluated, 56.6% were men with an average age of 58 years. The main etiology attributable to chronic kidney disease was hypertension in 92.8%, followed by type 2 diabetes in 71.8%, primary glomerulopathies in 6.9%, and hepatitis C and human immunodeficiency viruses in 0.3% each. The time in hemodialysis was 19 months. Anemia was identified in 93%. The risk of liver fibrosis was identified at 29.5%, and of these, 8% had a FIB4 > 2.67, indicating advanced liver fibrosis. Conclusions: The FIB4 is an accessible and useful method for identifying the risk of liver fibrosis in end-stage renal disease patients undergoing hemodialysis and can be used as an initial tool for assessing liver disease.