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Performance of liver test and transiet elastography in detection of non-alcoholic fatty liver disease (NAFLD) in patients with chronic renal failure and coronary heart disease

BACKROUND AND OBJECTIVES:Preliminary data suggested an association between chronic kidney disease (CKD) and non-alcoholic fatty liver disease (NAFLD). 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 investigated the usefulness of four liver tests and four biological scores in detection of NAFLD in comparasion with transiet elastography (TE) findings in different groups of patients. PATIENTS AND METHODS:Of 202 patients there were 52 patients with CKD, 50 patienst 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®-CAP, Echosense, 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>238dB.m-1 and thus by definition NAFLD. We have found that ALT, AST and GGT levels were positevily correlated with CAP values while ALT and AST showed positive correlation with liver stiffness aquired 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:TE provides the opportunity of non-invasive screening for NAFLD as well as liver fibrosis in patients with CRF.

non-alcoholic fatty liver disease; liver tests; transiet elastography

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