# Variations in Estimated Glomerular Filtration Rate Across Countries in Patients With Metabolic Dysfunction‐Associated Steatotic Liver Disease and Their Association With Liver Fibrosis: A Multicenter Study

## TL;DR

This study finds that kidney function, measured by eGFR, varies across countries in people with liver disease, and is linked to liver fibrosis severity in Asians but not Europeans.

## Contribution

The study reveals ethnic and regional differences in eGFR and liver fibrosis associations among MASLD patients.

## Key findings

- European participants had lower eGFR and higher liver fibrosis compared to Asians.
- eGFR levels were inversely associated with liver fibrosis in Asians but not in Europeans.
- Chinese participants had the highest eGFR, while Romanian participants had the lowest.

## Abstract

Metabolic dysfunction‐associated steatotic liver disease (MASLD) has become the most prevalent chronic liver disease globally. Previous studies have shown that MASLD is an independent risk factor for chronic kidney disease (CKD), but the variations in estimated glomerular filtration rate (eGFR) levels across countries with different ethnic backgrounds have not been extensively reported. We enrolled 3308 participants with biopsy‐proven MASLD from 34 centers in this multinational study and analyzed the associations between eGFR and histological severity of liver fibrosis in different countries. European participants had lower eGFR levels (92.2 ± 20.7 vs. 104.7 ± 17.3 mL/min/1.73 m2) and significant liver fibrosis (61.4 vs. 32.4%) than Asian individuals. In Asia, Chinese participants had the highest mean eGFR level at 105.8 mL/min/1.73 m2, while Malaysian participants had the lowest at 87.3 mL/min/1.73 m2 (p < 0.001). In Europe, French participants had the highest mean eGFR level at 95.3 mL/min/1.73 m2, while Romanian individuals had the lowest at 81.1 mL/min/1.73 m2 (p < 0.001). eGFR levels were inversely associated with liver fibrosis in Asian individuals (OR: 0.793, 95%CI: 0.685–0.917, p = 0.002), even after adjusting for traditional renal risk factors, but not in Europeans. Our findings provide the basis for further investigation of the burden of MASLD on CKD risk in different countries.

A total of 3308 participants with biopsy‐proven MASLD from 34 centers were enrolled in the study. We collected liver biopsy pathological scores and clinical parameters and conducted correlation analysis. We finally found that eGFR levels are inversely associated with liver fibrosis in Asians, even after adjusting for traditional renal risk factors.