الفهرس 
NON ALCOHOLIC FATTY LIVER DISEASEOnly 14 pages are availabe for public view
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Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. It is defined as the accumulation of fat (>5%) in liver cells in the absence of excessive alcohol intake or other causes of liver disease including autoimmune, drug-induced, or viral hepatitis, The histologic spectrum of NAFLD ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), liver fibrosis, and cirrhosis. But, the prevalence of NAFLD in patients undergoing dialysis remains unclear. Moreover, a meta-analysis showed that the CAP has good sensitivity and specificity for detecting hepatic steatosis there have only been limited reports regarding the use of CAP to evaluate hepatic steatosis in hemodialysis patients.
Objective: The aim of the study is to evaluate the frequency of NAFLD among non-diabetic end-stage renal disease (ESRD) patients on regular HD by measuring Controlled Attenuation Parameter (CAP) using transient elastography (TE) (Fibroscan®).
Methodology: This is a Cross-sectional study included 50 ESRD adults patients on regular HD >6 months randomly selected from HD units of the National Institute of Nephrology and Urology, Cairo, Egypt. The study Period from Jan 2018 to June 2018. Diabetic patients, BMI ≥ 30, Alcohol abuse, Patients with decompensated liver disease with ascites, Patients with seropositive HBV, HIV and HCV, or using drugs known to induce hepatic steatosis were excluded from the study. Complete blood count, routine blood chemistry, liver function tests, ferritin, T SAT%, CRP titer, and lipid profile were done. Urea reduction ratio (URR), KT/V were measured as parameters of HD adequacy.
Results: Fifty ESRD patients on HD {30 (60.0%) Males, 20(40.0%) females}, with mean age 48.62 ± 13.13 yrs., HD mean duration was 4.02 ± 2.57 yrs., mean of BMI 28.13 ± 1.02 (Kg/m2), 28(56%) of patients were hypertensive. 29 (58.0%) of studied patients were NAFLD with mean ±SD of CAP values was 229.72 ± 60.05 (dB/m). Distribution of CAP steatosis grades among HD patients with NAFLD were {14 (28.0%) patients with S1, 7(14.0%) S1 – S2, 2 (4.0%) S2, and 6(12.0%) Patients with S3 grade. Mean ± SD of Liver stiffness value was 6.80 ± 6.08 (Kpa) among patients with NAFLD, as 14(48.3%) patient with F1 grade, 3(10.2%) patients grade from F2-F3 and 12(41.4 %) patients with F0 grade. Mean of CRP titre 18.36 ± 21.92(mg/L), serum ALT 43.58 ± 26.89 (U/L), AST 36.80 ± 24.04(U/L), Bilirubin0.85 ± 0.31 (mg/dl), Cholesterol 199.68 ± 27.12(mg/dL), Triglycerides 171.12 ± 28.96 (mg/dL), LDL 123.0 ± 27.94(mg/dL), HDL 53.18 ± 7.24 (mg/dL), albumin 3.46 ± 0.38 (g/dl), URR%59.90 ± 3.95 and the mean of KTV was 1.29 ± 0.12. There was association between the presence of NAFLD and degree of Liver stiffness grade (X2 = 12.808, MCP = 0.002), Evident history of cardiovascular disease among patients with NAFLD (X2=6.378, MCP= 0.023). A significant statistical association between presence of NAFLD and increasing serum level of ALT, AST, total Cholesterol, TG and LDL (P<0.01).
Conclusions: There is a high frequency of Non-alcoholic fatty liver disease (58%) among non-diabetic, non-obese ESRD patients on regular HD, associated with increasing degree of liver stiffness, and accompanied with an increased risk of cardiovascular disease