| Abstract | Cilj istraživanja: Utvrditi incidenciju nealkoholne masne bolesti jetre (NAFLD) kod bolesnika s kroničnom bubrežnom bolesti (KBB), utvrditi je li NAFLD povezan sa smanjenom bubrežnom funkcijom kod bolesnika s KBB i bolesnika nositelja bubrežnog transplantata te utvrditi je li NAFLD povezan s povećanim kardiovaskularnim rizikom (KVB) kod bolesnika koji se liječe hemodijalizom (HD) i bolesnika s bubrežnim transplantatom.
Ispitanici i metode: U ispitivanje smo uključili 206 bolesnika s KBB, koji su bili podijeljeni u tri skupine. Prvu skupinu činila su 62 bolesnika s III i IV stadijem KBB, drugu 71 bolesnik na liječenju HD, a treću skupinu činila su 73 bolesnika s bubrežnim transplantatom (RTRs). Kontrolnu skupinu činilo je 50 zdravih ispitanika
Rezultati: Kod 85,5% bolesnika s III i IV stadijem KKB ustanovljen je NAFLD. Stupanj steatoze jetre pokazao je značajnu pozitivnu korelaciju s vrijednostima serumskog kreatinina (sCR) (p<0,01) ) i C-reaktivnog proteina (CRP) (p<0,05) te značajnu negativnu korelaciju s glomerularnom filtracijom (eGFR) (p<0,01) i serumskim željezom (p<0,01). NAFLD je detektiran u 52,1% HD bolesnika, a ti bolesnici su imali uznapredovalu aterosklerozu karotidnih arterija i veću incidenciju neželjenih KVB događaja. U trećoj skupini, NAFLD je detektiran u 57,5%. RTRs s NAFLD-om imali su statistički značajno veće vrijednosti sCR-a (p<0,0001), ureje (p<0,0001) ) i CRP-a (p<0,0001) te značajno niže vrijednosti eGFR-a (p<0,0001), serumskog željeza i hemoglobina u odnosu na bolesnike bez NAFLD-a, kao i veći stupanj zadebljanja intime i medije karotidnih arterija i veći postotak aterosklerotskih plakova. Niti jedan od analiziranih bioloških markera za procjenu fibroze/steatoze jetre nije se pokazao učinkovitim u detekciji NAFLD-a kod bolesnika s KBB.
Zaključak: Ispitanici s KBB imali su visoku učestalost NAFLD-a. Bolesnici koji se liječe HD i RTRs kod kojih je detektiran NAFLD imali su uznapredovalu karotidnu aterosklerozu. Kod bolesnika s KBB stadij III i IV i RTRs-a, NAFLD je bio udružen s nižim stupnjem bubrežne funkcije. |
| Abstract (english) | Objectives: The aim of this analysis was to investigate the incidence of nonalcoholic fatty liver disease (NAFLD) in patients with chronic kidney disease (CKD). We were interested to explore the association between NAFLD and decreased kidney function in patients CKD grade III and IV, as well as in renal transplant recipients (RTRs). Furhermore, we were interested to analyze whether the presence of NAFLD is associated with a higher cariovascular (CVD) risk in hemodialysis (HD) patients and RTRs.
Patients and Methods: In this cross-sectional analysis we were analyzed 206 CKD patients. The patients were divided into three subgroups. The first group consited of 62 CKD patients grade III and IV; second group consited of 71 HD patients and third group of 73 RTRs. Fifthy sex- and age- matched subjects served as controls.
Results: Out of 62 CKD patients grade III and IV, 85.5% had NAFLD. The severity of liver steatosis was positively correlated with serum creatinine (sCR) (p<0.01) and C-reactive protein (CRP) (p<0.05), and negatively correlated with glomerular filtration rate (GFR) (p<0.01). NAFLD was found in 52.1% of HD patients. HD patients with NAFLD shows more carotid atherosclerosis and more adverse CVD events than HD patients without NAFLD and control subjects. Furthermore, NAFLD was present in 57.5% of RTRs. We have founded that RTRs with NAFLD had statistically significant higher values of sCR (p<0.0001), urea (p<0.0001) and CRP (p<0.0001) in comparasion to the RTRs without NAFLD. On the other hand, RTRs with NAFLD had significantly lower values of GFR, serum iron and hemoglobin values in comparasion to RTRs without NAFLD. RTRs with NAFLD shows more carotid atherosclerosis than RTRs without NAFLD and control subjects. None of the investigated liver test and biological scores for predicting fibrosis/steatosis of the liver showed any differences between those CKD patients who had NAFLD compared to those without NAFLD.
Conclusion: CKD patients have high prevalence of NAFLD. HD and RTRs with NAFLD showe an advanced carotid atherosclerosis.NAFLD was associated with decreased kidney function in patients CKD grade III and IV, as well as in RTRs. |
