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Nonalcoholic fatty liver disease and the renin-angiotensin system blockers in the patients with chronic kidney disease

Nicht-alkoholische Fettleber und Blocker des Renin-Angiotensin Systems bei Patienten mit chronischer Nierenerkrankung

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Summary

Background

Recent data suggest that the renin-angiotensin-aldosteron system (RAAS) may be of importance in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). We were interested to investigate whether the therapy with RAAS blockers in patients with different stages of chronic kidney disease (CKD) has any effect on steatosis and fibrosis grade; NAFLD documented by transient elastography (TE) (Fibroscan®-CAP).

Methods

Of 191 patients with various stages of CKD there were 61 patients with CKD grade III and IV, 62 patients with end-stage renal disease treated with chronic hemodialysis and 68 renal transplant recipients. Liver stiffness was selected as the parameter to quantify liver fibrosis. Furthermore, the Controlled Attenuation Parameter (CAP) was used to detect and quantify liver steatosis with the help of TE.

Results

CKD patients (p = 0.005) and CKD-NAFLD patients (p = 0.0005) with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) had statistically significant lower degree of liver stiffness in comparison to those without these medications (p = 0.005). Also, we were interested to explore is there any difference in fibrosis and steatosis grade due to use of ACE-I or ARBs. We did not find statistically significant differences between those two subgroups of patients with respect to liver steatosis/fibrosis.

Conclusion

Based on our results, RAAS blockers could be an attractive option for the management of NAFLD. We believe that TE provides the opportunity of noninvasive screening of NAFLD in CKD patients. In further prospective analysis, we believe that by using TE as noninvasive method we could investigate are ACE-I/ARBs really effective medications for the treatment of NAFLD in CKD patients.

Zusammenfassung

Grundlagen

Kürzlich berichtete Ergebnisse deuten darauf hin, dass das Renin-Angiotensin System (RAAS) von Bedeutung für die Pathogenese der nicht-alkoholischen Fettleber (NAFLD) sein könnte. Wir untersuchten, ob bei Patienten mit verschiedenen Stadien einer chronischen Nierenerkrankung (CKD) eine Therapie mit Blockern des RAAS eine Wirkung auf den Steatose- beziehungsweise Fibrose-Grad (dokumentiert mittels transienter Elastographie (TE) – Fibroscan®-CAP) der Leber ausübt.

Methodik

Es wurden 191 Patienten mit verschiedenen Stadien der Niereninsuffizienz untersucht: 61 Patienten waren im Stadium III der CKD, 62 Patienten waren im Endstadium der Niereninsuffizienz und an der chronischen Hämodialyse, 68 Patienten waren Nierentransplantatempfänger. Als Parameter zur Quantifizierung der Leberfibrose wurde die Steifheit der Leber herangezogen. Außerdem wurde mit Hilfe der TE der „Controlled Attenuation Parameter (CAP)“ zur Erkennung und Quantifizierung einer Steatose der Leber verwendet.

Ergebnisse

Die CKD Patienten (p = 0,05) und die CKD-NAFLD Patienten (p = 0,0005), die mit ACE Hemmern oder Angiotensinrezeptorblockern behandelt worden waren, hatten im Vergleich zu den Patienten ohne diese Medikation einen statistisch signifikant niedrigeren Grad der Lebersteifheit. In Bezug auf die Steatose beziehungsweise den Fibrosegrad der Leber war kein statistisch signifikanter Einfluss der Medikation zu erheben.

Schlussfolgerung

Unsere Ergebnisse lassen den Schluss zu, dass RAAS Blocker eine attraktive Option beim Management der NAFLD sein könnten. Wir glauben, dass die TE eine Möglichkeit bietet, bei CKD Patienten nicht invasiv auf NAFLD zu screenen.

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Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Tome Strižića 3, 51000, Rijeka, Croatia

    Lidija Orlic MD, PhD, Ivana Mikolasevic MD, Ita Jelic MD & Sanjin Racki MD, PhD

  2. Department of Internal Medicine, General Hospital “Dr. Josip Bencevic”, Slavonski Brod, Croatia

    Vesna Lukenda MD

  3. Infectious Disease Clinic, UHC Osijek, Osijek, Croatia

    Kata Anic MD

Authors
  1. Lidija Orlic MD, PhD
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  2. Ivana Mikolasevic MD
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  3. Vesna Lukenda MD
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  4. Kata Anic MD
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  5. Ita Jelic MD
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  6. Sanjin Racki MD, PhD
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Correspondence to Ivana Mikolasevic MD.

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Orlic, L., Mikolasevic, I., Lukenda, V. et al. Nonalcoholic fatty liver disease and the renin-angiotensin system blockers in the patients with chronic kidney disease. Wien Klin Wochenschr 127, 355–362 (2015). https://doi.org/10.1007/s00508-014-0661-y

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  • DOI: https://doi.org/10.1007/s00508-014-0661-y

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