Association of noninvasive tests of liver fibrosis with chronic kidney disease in MASLD: a systematic review and meta-analysis.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging risk factor for chronic kidney disease (CKD). While liver biopsy is the gold standard for assessing fibrosis, noninvasive tests (NITs)-including fibrosis-4 (FIB-4), nonalcoholic fatty liver disease fibrosis score (NFS), and vibration-controlled transient elastography-are validated alternatives. However, their association with CKD stage in MASLD remains unclear. This study aimed to evaluate the association between NITs and various CKD outcomes in MASLD. A systematic search identified observational studies published between January 2014 to July 2024 following PRISMA were included. Data extraction and risk-of-bias assessment were performed independently by multiple reviewers. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 33 studies comprising 278,355 MASLD were included. High FIB-4 were associated with increased risks of CKD stage ≥ 3 (adjusted OR (AOR): 2.23; 95%CI 1.40-3.53) and advanced CKD including ESRD (OR: 2.75; 95%CI 1.27-5.96). High NFS was associated with albuminuria (AOR: 1.68; 95%CI 1.19-2.38) and CKD stage ≥ 3 (AOR: 2.52; 95%CI 1.78-3.58). Elevated liver stiffness showed a strong association with CKD stage ≥ 3 (AOR: 3.12; 95%CI 2.16-4.49). NITs may serve as indicators of CKD staging in MASLD. Future studies should explore whether targeting liver fibrosis could mitigate CKD progression.