Impact of Metabolic Syndrome Traits on Kidney Disease Risk in Individuals with MASLD: A UK Biobank Study

ABSTRACT Background and Aims The impact of metabolic syndrome (MetS) traits on chronic kidney disease (CKD) risk in metabolic dysfunction‐associated steatotic liver disease (MASLD) is unknown. We investigated the impact of type and number of MetS traits and liver fibrosis on prevalent CKD and incident end‐stage renal disease (ESRD) risk in SLD. Methods 234 488 UK Biobank participants' were analysed. Hepatic steatosis index (> 36 for SLD, < 30 for no SLD) and MRI‐proton density fat fraction (≥ 5.56%) were used to identify SLD. MetS traits were identified using MASLD criteria. Advanced fibrosis (FIB‐4 score > 2.67) was determined using FIB‐4 scores. eGFR < 60 mL/min/1.73 m 2 or albuminuria > 3 mg/mmol identified prevalent CKD. A validated algorithm identified incident ESRD. Binary logistic and Cox regressions were used to test associations with prevalent CKD ([adjusted odds ratios (ORs)]) and incident ESRD (adjusted hazard ratios [HRs]) respectively. Results 102 410 participants (41.2%) had SLD. 64.4% had MetS. 1.3% had FIB‐4 score > 2.67. With SLD and only one MetS trait, hypertension (OR 1.35, 95% CI 1.35–1.72) or type 2 diabetes (T2D) (OR 1.89, 95% CI 1.06–3.38) increased risk of prevalent CKD. MetS (≥ 3 traits) increased prevalent CKD risk (OR 1.94, 95% CI 1.75–2.15), which was further increased by advanced liver fibrosis (OR 4.29, 95% CI 3.36–5.47). CKD prevalence increased with increasing MetS traits. Over 13.6 years (median follow‐up), MetS was associated with increased risk of developing ESRD (HR 1.70, 95% CI 1.19–2.43). Conclusions In MASLD, hypertension, and T2D, number of MetS traits and liver fibrosis increased risk of prevalent CKD and presence of MetS increased the risk of incident ESRD.