Risk of CKD in biopsy-proven metabolic dysfunction-associated steatotic liver disease.

Authors

Fahim Ebrahimi, Christian Eichhorn, Tracey G Simon, Jiangwei Sun, David Bergman, Carole A Marxer, Heba Alkhatib, Soran R Bozorg, Hannes Hagström, Juan J Carrero, Jonas F Ludvigsson

Published in

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. Jun 23, 2026. Epub Jun 23, 2026.

Abstract

There is scarce long-term data on the risk of chronic kidney disease (CKD) in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD). We hypothesize that the risk of CKD in MASLD is increased and may vary with worsening histological severity.
Nationwide matched cohort study including all Swedish adults with histologically confirmed MASLD from 1969 to 2017 (n = 11 082) without prior kidney disease [simple steatosis (n = 7 522), non-fibrotic metabolic dysfunction-associated steatohepatitis (MASH) (n = 1 257), non-cirrhotic fibrosis (n = 1 692) and cirrhosis (n = 611)]. Individuals were matched to ≤ 5 population comparators (n = 52 645). The primary endpoint consisted of incident CKD, kidney failure with replacement therapy (KFRT; initiation of dialysis or kidney transplant) or death from kidney disease. Multivariable Cox regression was used to estimate adjusted hazard ratios (aHRs). Individuals with MASLD with at least one sibling were compared to their full siblings.
Over a median of 17.6 years, 878 individuals with MASLD (incidence rate [IR] 53.1/10 000 person-years) vs. 2 643 comparators (IR 27.4) developed the composite CKD outcome. This was equal to one additional composite outcome event in 39 individuals with MASLD followed for ten years and corresponded to an aHR of 1.85 (95% confidence interval [CI] 1.68 - 2.04). The HR increased with worsening histological severity of MASLD (Ptrend < 0.001). Individuals with MASLD were at an almost two-fold increased hazard of CKD (aHR 1.83; 95% CI 1.66 - 2.02) and three-fold increased hazard of KFRT (aHR 2.88; 95% CI 2.32 - 3.57). Findings were robust and consistent across sensitivity and secondary analyses, including when individuals with MASLD were compared to their full biological siblings.
Individuals with biopsy-proven MASLD were at higher risk of developing CKD compared to both the general population and siblings. Excess risks were evident across all histological stages of MASLD and increased with worsening histologic severity.

PMID:
42335946
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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