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Liver fibrosis linked to CV events, survival in NAFLD, chronic kidney disease

After a median follow-up of 10 years, NAFLD correlated with an increased risk for: “Variable A” – Cardiovascular events; HR = 1.39 “Variable B” – All-cause mortality; HR = 1.1

Source:

Hydes T, et al. Abstract OS048. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).


Disclosures:
Hydes reports no relevant financial disclosures.


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LONDON — Elevated noninvasive markers of liver fibrosis correlated with an increased risk for cardiovascular events, end-stage renal disease and worse survival in patients with chronic kidney disease and nonalcoholic fatty liver disease.

“Multimorbidity is increasing, and it is vital to understand the clinical consequences of having more than one medical condition,” Theresa Hydes, MBBS, BSc, PhD, NIHR clinical lecturer in hepatology at the University of Liverpool, told Healio. “Fatty liver disease, in particular, is independently associated with several non-liver conditions, including heart disease and chronic kidney disease.”


After a median follow-up of 10 years, NAFLD correlated with an increased risk for: “Variable A” – Cardiovascular events; HR = 1.39 “Variable B” – All-cause mortality; HR = 1.1



Seeking to assess the effect of NAFLD and NAFLD fibrosis on adverse clinical outcomes and mortality among patients with chronic kidney disease (CKD), Hydes and colleagues analyzed data from 26,074 patients using the UK Biobank. Participants provided information related to medical history, demographics and lifestyle factors, which was supplemented via electronic linkage to hospital records and death records.

Researchers used Cox regression to estimate hazard ratios associated with NAFLD and advanced liver fibrosis on CV events, progression to end-stage renal disease (ESRD) and all-cause mortality.

At baseline, 54,5% of patients with CKD had NAFLD, with evidence of advanced fibrosis among 7% [NAFLD fibrosis score (NFS) 0.676], 3.2% [elevated fibrosis-4 (FIB-4) > 2.67] and 1.1% [AST to platelet ratio index (APRI) 1].

After a median follow-up of 10 years, NAFLD correlated with an increased risk for CV events (HR = 1.39; 95% CI, 1.29-1.51) and all-cause mortality (HR = 1.1; 95% CI, 1.01-1.19) but not ESRD (HR = 1.22; 95% CI, 0.95-1.56) in a univariate analysis. Following multivariate adjustment for demographics, metabolic factors and baseline renal functions, NAFLD did not associate with an increased risk for primary outcomes.

Advanced liver fibrosis using all scores correlated with an increased risk for all-cause mortality (HR = 2.34-2.9), and NFS and FIB-4 associated with an elevated risk for CV events (HR = 2.49; 95% CI, 2.11-2.93 and HR = 1.94; 95% CI, 1.53-2.45) and ESRD (HR = 6.85; 95% CI, 4.29-10.94 and HR = 2.35; 95% CI, 1.19-4.67). After full adjustment, FIB-4 correlated with an increased incidence of CV events (HR = 1.39; 95% CI, 1.06-1.82), notably heart failure (HR = 1.65; 95% CI, 1.16-2.33).

Both FIB-4 and APRI associated with all-cause mortality (HR = 1.55; 95% CI, 1.21-2 and HR = 2.83; 95% CI, 1.95-4.11) and NFS ( –1.455) associated with progression to ESRD (HR = 1.89; 95% CI, 1.13-3.17).

“These results highlight the importance of enhanced recognition of fatty liver disease with fibrosis in people with chronic kidney disease to inform the need for vigorous cardiometabolic risk factor control in this group,” Hydes said. “It also suggests the need for work to understand the mechanisms linking these conditions to help drive new drug discoveries.”

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Timmins winter hiking event highlights outdoor survival, adventure and education

Timmins winter hiking event highlights outdoor survival, adventure and education


The Wintergreen Fund for Conservation‘s first winter hiking day after a pandemic hiatus saw a healthy turnout of people looking to learn more about the Hersey Lake Conservation Area and the opportunities for adventure and education within it.


Members of the board said it was encouraging to see people brave the elements so that volunteers could show them aspects of their local trails that may have passed them by.


“They just get to see a different aspect of the different seasons,” said board member Michele Lepage.


“We are fortunate to have these trails and this conservation so close to our municipality… To have this access is just great. We just have to make people aware of what we have.”


Wintergreen held guided hikes with focuses on birdwatching, forest therapy, forest education and the history of the conservation area.


The day also saw the return of survival demonstrations from Timmins Porcupine Search and Rescue—which included crash courses on making signal fires when lost in the bush, Swedish fire logs, snow trenches for staying out of harsh winds and classic Canadian quinzees for quick shelter from the elements.


“It feels good to be out in the community and interact and see people again,” said search and rescue volunteer Shane Lebrun.


“It’s been a long two years and it’s nice to see people outdoors.”