Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study
April
Using controlled attenuation parameter combined with ultrasound to survey non- alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study
Yi-Hao Yen 0 1
Jin-Bor Chen 1
Ben-Chung Cheng 1
Jung-Fu Chen 1
Kuo-Chin Chang 0 1
Po- Lin Tseng 0 1
Cheng-Kun Wu 0 1
Ming-Chao Tsai 0 1
Ming-Tsung Lin 0 1
Tsung-Hui Hu 0 1
0 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 2 Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 3 Division of Endocrinology & Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung , Taiwan
1 Editor: Han-Chieh Lin, Taipei Veterans General Hospital , TAIWAN
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Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: This work was supported by Grant
CMRPG8B1171 from Chang Gung Memorial
Hospital-Kaohsiung Medical Center; Taiwan. The
funders had no role in study design, data collection
and analysis, decision to publish, or preparation of
the manuscript.
Background and aims
patients.
Method
Controlled attenuation parameter (CAP) is a non-invasive method for measuring hepatic steatosis (HS). Non-alcoholic fatty liver disease (NAFLD) is closely related to cardiovascular diseases (CVDs). CVDs are the leading cause of morbidity and mortality in hemodialysis patients. The aim of this study was to investigate the prevalence of NAFLD in hemodialysis
We prospectively enrolled patients undergoing chronic hemodialysis, as well as patients
with normal renal function who served as controls. The control group patients were referred
by an endocrinologist to be tested for NAFLD; most of these patients had diabetes,
hypertension, or dyslipidemia. We excluded those with excess alcohol intake, use of drugs known
to induce HS, chronic viral hepatitis, or CAP failure. CAP
238 dB/m was used as a cutoff
suggesting HS. An increased liver kidney contrast, as defined by ultrasound, was used to
make the diagnosis of HS.
Results
Three hundred and forty-three hemodialysis patients and 252 control group patients were
enrolled. Among the hemodialysis patients, 192 (56.0%) had CAP- or ultrasound-identified
HS compared with 91 (26.5%) who only had ultrasound-identified HS (P<0.001). Among the
control group patients, 212 (84.1%) had CAP- or ultrasound-identified HS compared with
180 (71.4%) who only had ultrasound-identified HS (P<0.001).
Competing interests: The authors have declared
that no competing interests exist.
Conclusions
The prevalence of NAFLD in the hemodialysis patients was 56%. The number of diagnoses
of NAFLD made by using CAP combined with ultrasound was more than 2 times the number
made with ultrasound alone in the hemodialysis patients. Therefore, we suggest the use of
CAP combined with ultrasound to screen for NAFLD in hemodialysis patients.
Introduction
It is well known that cardiovascular diseases (CVDs) are the leading cause of morbidity and
mortality in chronic kidney disease patients [1±6]. In patients who undergo dialysis treatment,
there are well established risk factors that contribute to the development of CVDs, including
hypertension, diabetes, dyslipidemia, and being overweight [
7
].
Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity, insulin
resistance, hypertension, and dyslipidemia, and is now regarded as the liver manifestation of
metabolic syndrome [8±10], which is a highly atherogenic condition, even at a very early age [11±
13]. Natural history studies have reported that the increased age-related mortality observed in
patients with NAFLD is attributable to cardiovascular as well as liver-related deaths [
11,14
].
According to these observations, hemodialysis patients who develop NAFLD because of
shared etiological factors (such as the components of metabolic syndrome) probably have a
much faster progression of the atherosclerotic process and development of adverse CVD
events than patients without NAFLD [
15
]. That said, the prevalence of NAFLD in patients
undergoing dialysis remains unclear. However, the main risk factors responsible for the
development of NAFLD are commonly observed in dialysis patients. Therefore, it is logical to
expect that end-stage renal disease (ESRD) patients on maintained hemodialysis would also
have a high prevalence of NAFLD.
The controlled attenuation parameter (CAP) is a technology that is used to measure the
degree of ultrasound (US) attenuation by hepatic fat at the central frequency of the FibroScan
(Echosens, Paris, France) [
16
]. A FibroScan measurement is also less likely to be influenced by
sampling error than a liver biopsy because it is made by exploring a liver volume approximately
100 times (...truncated)