SP278IMPACT OF NON-ALCOHOLIC FATTY LIVER DISEASE ON CARDIOVASCULAR OUTCOMES AND MORTALITY IN ADVANCED CHRONIC KIDNEY DISEASE

Abstract

INTRODUCTION AND AIMS: Non-Alcoholic Fatty Liver Disease(NAFLD) is regarded as the hepatic component of metabolic syndrome and is associated with a high risk of developing Cardiovascular disease(CVD). NAFLD is also considered to be a risk factor for CKD and CKD contributes to NAFLD pathogenesis within a vicious cycle by oxidative stress and an inflammatory Milieu. AIMS: To study the association of NAFLD on Cardiovascular Outcomes and mortality in a cohort of patients with advanced CKD. METHOD(S): All patients recruited in the Salford Kidney Study (SKS) who had an Ultrasound (US) of the liver performed between January 2000 to December 2014 were sampled in this retrospective observational study. Follow up data on Major Cardiovascular Events(MACE) (Non-Fatal MI, Congestive Cardiac Failure, Cerebrovascular Accidents, Peripheral Vascular Disease) was collected for all patients from the date of Ultrasound (study start date), until the study end which included commencement of Renal Replacement Therapy (RRT) or eGFR <10 ml/min, loss to follow up or Death. Data was obtained from electronic patient records including baseline patient characteristics and blood results, and was analysed using SPSS software RESULTS: Of the 3061 patients registered in the SKS, 1419 patients had a liver US during the study period. After excluding patients based on pre-set exclusion criteria (eg: liver disease from other causes), a sample of 852 (183 NAFLD and 669 with normal liver US) patients with complete datasets was achieved on whom comparative analysis was performed. At baseline, median age of the study group was 66 years and median eGFR was 33.5 mL/min/1.73m2. Patients with NAFLD had more Hypertension, Diabetes and Hypercholesterolemia. Body Mass Index was significantly higher in NAFLD group 31 vs 27 kg/m2(p= <0.0001). Median value of ALT and GGT was statistically higher(p<0.01) in the NAFLD group. Median Follow up time was 73 months with no difference between groups(p=0.176). A total of 46(25.13%) MACE were recorded in the NAFLD group compared to 82 (12.25%) in the Normal US group (p<0.05). Multivariate Cox-Regression Models showed NAFLD as an independent risk factor (HR 2.04, p<0.001) for MACE even after adjustment for all factors of the Metabolic Syndrome and Cardiovascular risk in the model (Table). There was no significant difference in survival between the two groups over the follow-up period (p>0.05) as shown in Kaplan-Meyer Survival Curve. CONCLUSION(S): Our study has shown, that NAFLD has a strong independent association with CV events, even in an advanced CKD population with high comorbidity. Although Liver functions test were higher in the NAFLD group, these were generally not high enough to justify routine screening for liver disease. Further prospective studies are needed to guide a screening strategy for this important hidden risk factor and to tailor interventions to prevent CVD in this high risk comorbid population. (Figure Presented).