Francesc Moncho, Salvador Benlloch, Jose Luis Górriz
{"title":"代谢功能障碍相关脂肪变性肝病(MASH)对CKD中心血管疾病高风险的影响:相互联系和管理","authors":"Francesc Moncho, Salvador Benlloch, Jose Luis Górriz","doi":"10.1093/ckj/sfaf260","DOIUrl":null,"url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major contributor to systemic metabolic dysfunction and is increasingly recognized as a risk enhancer for both cardiovascular disease (CVD) and chronic kidney disease (CKD). This review explores the complex interconnections between MASLD, CVD, and CKD, with emphasis on shared pathophysiological mechanisms and the clinical implications for risk assessment and management. We describe the crosstalk among the liver, heart, and kidneys, focusing on insulin resistance, chronic inflammation, and progressive fibrosis as key mediators. The severity of liver fibrosis in MASLD is independently associated with both cardiovascular and renal outcomes. Conventional cardiovascular risk scores may underestimate risk in MASLD-CKD populations, highlighting the need for integrated approaches that include hepatic, renal, and metabolic profiling. We also review current non-invasive diagnostic tools, including fibrosis scores and cardiovascular biomarkers, as well as emerging genetic and epigenetic markers that may enhance risk stratification. The therapeutic landscape is evolving, with promising results from lifestyle interventions and pharmacological agents such as GLP-1 receptor agonists, SGLT2 inhibitors, and novel antifibrotic compounds. We also propose a practical algorithm for the screening and risk stratification of MASLD in CKD patients, incorporating non-invasive fibrosis assessment and cardiometabolic risk evaluation. This stepwise approach supports early detection and personalized management, particularly in patients with CKD or type 2 diabetes. In conclusion, MASLD significantly amplifies cardiovascular and renal risk. Early, multidisciplinary intervention is essential to improve long-term outcomes in this high-risk population.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf260"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415520/pdf/","citationCount":"0","resultStr":"{\"title\":\"The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.\",\"authors\":\"Francesc Moncho, Salvador Benlloch, Jose Luis Górriz\",\"doi\":\"10.1093/ckj/sfaf260\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major contributor to systemic metabolic dysfunction and is increasingly recognized as a risk enhancer for both cardiovascular disease (CVD) and chronic kidney disease (CKD). This review explores the complex interconnections between MASLD, CVD, and CKD, with emphasis on shared pathophysiological mechanisms and the clinical implications for risk assessment and management. We describe the crosstalk among the liver, heart, and kidneys, focusing on insulin resistance, chronic inflammation, and progressive fibrosis as key mediators. The severity of liver fibrosis in MASLD is independently associated with both cardiovascular and renal outcomes. Conventional cardiovascular risk scores may underestimate risk in MASLD-CKD populations, highlighting the need for integrated approaches that include hepatic, renal, and metabolic profiling. We also review current non-invasive diagnostic tools, including fibrosis scores and cardiovascular biomarkers, as well as emerging genetic and epigenetic markers that may enhance risk stratification. The therapeutic landscape is evolving, with promising results from lifestyle interventions and pharmacological agents such as GLP-1 receptor agonists, SGLT2 inhibitors, and novel antifibrotic compounds. We also propose a practical algorithm for the screening and risk stratification of MASLD in CKD patients, incorporating non-invasive fibrosis assessment and cardiometabolic risk evaluation. This stepwise approach supports early detection and personalized management, particularly in patients with CKD or type 2 diabetes. In conclusion, MASLD significantly amplifies cardiovascular and renal risk. Early, multidisciplinary intervention is essential to improve long-term outcomes in this high-risk population.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 9\",\"pages\":\"sfaf260\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415520/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf260\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf260","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major contributor to systemic metabolic dysfunction and is increasingly recognized as a risk enhancer for both cardiovascular disease (CVD) and chronic kidney disease (CKD). This review explores the complex interconnections between MASLD, CVD, and CKD, with emphasis on shared pathophysiological mechanisms and the clinical implications for risk assessment and management. We describe the crosstalk among the liver, heart, and kidneys, focusing on insulin resistance, chronic inflammation, and progressive fibrosis as key mediators. The severity of liver fibrosis in MASLD is independently associated with both cardiovascular and renal outcomes. Conventional cardiovascular risk scores may underestimate risk in MASLD-CKD populations, highlighting the need for integrated approaches that include hepatic, renal, and metabolic profiling. We also review current non-invasive diagnostic tools, including fibrosis scores and cardiovascular biomarkers, as well as emerging genetic and epigenetic markers that may enhance risk stratification. The therapeutic landscape is evolving, with promising results from lifestyle interventions and pharmacological agents such as GLP-1 receptor agonists, SGLT2 inhibitors, and novel antifibrotic compounds. We also propose a practical algorithm for the screening and risk stratification of MASLD in CKD patients, incorporating non-invasive fibrosis assessment and cardiometabolic risk evaluation. This stepwise approach supports early detection and personalized management, particularly in patients with CKD or type 2 diabetes. In conclusion, MASLD significantly amplifies cardiovascular and renal risk. Early, multidisciplinary intervention is essential to improve long-term outcomes in this high-risk population.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.