Document Type

Clinical Science Research

Date of Poster


Date of Submission

May 2020


Background: Non-alcoholic fatty liver disease (NAFLD) risk factors including metabolic syndrome (MS) and its components obesity (BMI ≥ 30), diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DL), has an increased prevalence in end stage renal disease (ESRD). The goal of study was to assess utility of non-invasive testing (NIT) including transient elastography (TE) for liver stiffness (LS), controlled attenuated parameter (CAP) for steatosis, Fibrosis-4 (FIB-4), AST to platelet ratio (APRI) and NAFLD Fibrosis score (NFS), for assessment of NAFLD in patients with ESRD undergoing renal transplant (RT) evaluation.

Methods: Demographic, clinical and laboratory data were collected within 12 weeks of TE. Primary outcomes were significant fibrosis (SF) and steatosis, defined by TE ≥ 9 kPa and CAP ≥ 263 dB/m, respectively. Univariate analysis was performed to identify factors associated with SF and steatosis. In those with available liver histology, utility of LS, FIB-4 and NFS to predict SF was assessed.

Results: Total of 171 patients were evaluated. Mean age was 56 years, 65% male, 60% African American, 36% obese, 47% had DM, 96% had HTN, and 56% had DL. Median (IQR) LS was 6.5 kPa (4.7-8.9) with 21% having SF (>F2). Mean CAP was 232 dB/m with 25% having steatosis. Those with SF were older (62 vs. 54 years; p=.005) and had higher NFS (0.138 vs. 0.560; p=0.021). Those with steatosis had obesity and DM without higher fibrosis. Those with liver histology (N=14), SF was associated with LS ≥ 9 kPa (p=.037) but not with APRI, FIB-4, or NFS.

Conclusion: Amongst patients with ESRD being evaluated for RT, there was a high prevalence of LS. Normal liver enzymes, SF and steatosis were common, yet these were not detected by APRI or FIB-4. Patient’s who are at low risk for SF can be identified by NFS and TE with moderate negative predictive value and specificity.


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VCU School of Medicine GME Resident and Fellow Research Day Posters