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

IF 4.6 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2025-08-12 eCollection Date: 2025-09-01 DOI:10.1093/ckj/sfaf260
Francesc Moncho, Salvador Benlloch, Jose Luis Górriz
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引用次数: 0

摘要

代谢功能障碍相关的脂肪变性肝病(MASLD)已成为全身性代谢功能障碍的主要因素,并且越来越被认为是心血管疾病(CVD)和慢性肾脏疾病(CKD)的风险增强因素。这篇综述探讨了MASLD、CVD和CKD之间的复杂联系,重点是共同的病理生理机制以及风险评估和管理的临床意义。我们描述了肝脏、心脏和肾脏之间的相互作用,重点是胰岛素抵抗、慢性炎症和进行性纤维化作为关键介质。MASLD患者肝纤维化的严重程度与心血管和肾脏预后独立相关。传统的心血管风险评分可能低估了MASLD-CKD人群的风险,强调需要包括肝、肾和代谢分析在内的综合方法。我们还回顾了目前的非侵入性诊断工具,包括纤维化评分和心血管生物标志物,以及可能增强风险分层的新出现的遗传和表观遗传标志物。治疗前景正在发展,生活方式干预和药理学药物如GLP-1受体激动剂、SGLT2抑制剂和新型抗纤维化化合物带来了有希望的结果。我们还提出了一种实用的算法,用于CKD患者MASLD的筛查和风险分层,包括非侵入性纤维化评估和心脏代谢风险评估。这种循序渐进的方法支持早期发现和个性化管理,特别是对于CKD或2型糖尿病患者。总之,MASLD显著增加心血管和肾脏风险。早期多学科干预对于改善这一高危人群的长期预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.

The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.

The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.

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.

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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
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.
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