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Nonalcoholic fatty liver disease and the renin-angiotensin system blockers in the patients with chronic kidney disease

Recent data suggest that the renin-angiotensin-aldosteron system (RAAS) may be of importance in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). We were interested to investigate whether the therapy with RAAS blockers in patients with different stages of chronic kidney disease (CKD) has any effect on steatosis and fibrosis grade ; NAFLD documented by transient elastography (TE) (Fibroscan®-CAP). Of 191 patients with various stages of CKD there were 61 patients with CKD grade III and IV, 62 patients with End-Stage renal disease treated with chronic haemodialysis and 68 renal transplant recipients. Liver stiffness was selected as the parameter to quantify liver fibrosis. Furthermore the Controlled Attenuation Parameter (CAP) was used to detect and quantify liver steatosis with the help of TE. CKD patients (p=0.005) and CKD-NAFLD patients (p=0.0005) with ACE-I or ARBs had statistically significant lower degree of liver stiffness in comparison to those without these medications (p=0.005). Also, we were interested to explore is there any difference in fibrosis and steatosis grade due to use of ACE-I or ARBs. We didn' t found statistically significant differences between those two subgroups of patients with respect to liver steatosis/fibrosis. Based on our results, RAAS blockers could be an attractive option for the management of NAFLD. We belive that TE provides the opportunity of non-invasive screening of NAFLD in CKD patients. In further prospective analysis, we believe that by using TE as non-invasive method we could investigate are ACE-I/ARBs really effective medications for the treatment of NAFLD in CKD patients.

renin-angiotensin-aldosteron system; nonalcoholic fatty liver disease (NAFLD); chronic kidney disease; transient elastography; non-invasive screening

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