TOPLINE

A Swedish cohort study found that patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD) had a higher risk for a composite chronic kidney disease (CKD) outcome than comparators from the general population without recorded MASLD and CKD, and this risk increased with worsening histologic severity of the liver disease.

METHODOLOGY

• Researchers conducted a cohort study to assess the long-term risk for CKD in adults with biopsy-proven MASLD and its association with disease severity.
• They included 11,082 Swedish adults with biopsy-proven MASLD (mean age at diagnosis, 53.8 years; 44.5% women) and no prior kidney disease and 52,645 matched individuals from the general population without recorded MASLD and CKD.
• Patients with MASLD were stratified on the basis of the histologic severity of the liver disease: those with simple steatosis (n = 7522), non-fibrotic metabolic dysfunction-associated steatohepatitis (MASH; n = 1257), non-cirrhotic fibrosis (n = 1692), and cirrhosis (n = 611).
• The primary outcome was a composite of incident CKD, kidney failure with replacement therapy (KFRT; defined as the initiation of dialysis or the receipt of a kidney transplant), or death attributed to CKD.
• Outcomes were assessed over a median follow-up duration of 17.6 years.

TAKEAWAY

• Over the follow-up period, 878 patients with MASLD developed the composite CKD outcome (incidence rate, 53.1 per 10,000 person-years), corresponding to an 85% higher risk than matched individuals (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.68-2.04).
• The risk for the composite CKD outcome increased progressively with worsening histologic severity of MASLD: simple steatosis (aHR, 1.69), non-fibrotic MASH (aHR, 2.13), non-cirrhotic fibrosis (aHR, 2.19), and cirrhosis (aHR, 2.86).
• MASLD was also associated with an 83% increased risk for incident CKD (aHR, 1.83; 95% CI, 1.66-2.02) and an approximately threefold increased risk for KFRT (aHR, 2.88; 95% CI, 2.32-3.57).
• When individuals with MASLD with at least one sibling were compared to their full biological siblings, a twofold higher risk for the composite CKD outcome was observed (aHR, 2.01; 95% CI, 1.62-2.50).

IN PRACTICE

"[The study] findings provide robust evidence that MASLD is independently associated with CKD beyond established metabolic risk factors and underscore the need for heightened renal surveillance and integrated management in patients with MASLD," the authors wrote.

SOURCE

This study was led by Fahim Ebrahimi, Karolinska Institutet, Stockholm, Sweden. It was published online on June 23, 2026, in Nephrology Dialysis Transplantation.

LIMITATIONS

The study lacked data on important variables such as smoking status, BMI, laboratory results, and albuminuria, which may have resulted in residual confounding. The reliance on diagnosis codes rather than laboratory measurements likely led to an underascertainment of dyslipidaemia and mild or early-stage CKD. Additionally, selection bias may have existed as the inclusion based on biopsy may have been limited to patients with more advanced disease.

DISCLOSURES

Three authors reported receiving support from the Margot und Erich Goldschmidt & Peter René Jacobson Foundation, Svenska Sällskapet för Medicinsk Forskning, or the Swiss National Science Foundation. Some authors reported receiving research funding or financial support, serving as consultants or speakers or on advisory boards, and holding other ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.