Diabetes and Kidney Disease Together Triple Liver Fibrosis Risk, Study Finds
China: A large-scale U.S. analysis has revealed that people living with both type 2 diabetes (T2DM) and chronic kidney disease (CKD) face a dramatically higher risk of developing liver fibrosis compared to those with either condition alone. The research, led by Ting Xua and Weifang Zhu from China and published in Diabetes Research and Clinical Practice, examined data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and March 2020.
The study is among the first to comprehensively assess how CKD and T2DM—individually and together—relate to metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis (LF) using transient elastography, a non-invasive imaging technique considered more accurate than blood-based scoring systems.
Researchers analyzed data from 6,035 American adults and reported the following findings:
- MASLD (formerly called non-alcoholic fatty liver disease) was found in 27% of participants, while 16% had signs of liver fibrosis.
- Without excluding comorbidities, both CKD and T2DM independently increased the odds of having MASLD and LF.
- Compared to individuals without these conditions, CKD raised MASLD risk by 27% and LF risk by 82%, while T2DM more than doubled the risk for both outcomes.
- After excluding participants with overlapping conditions, CKD alone was not significantly linked to MASLD, whereas T2DM alone showed a strong association with higher MASLD risk.
- Having both CKD and T2DM did not increase MASLD risk beyond that of diabetes alone, but more than tripled LF risk compared to those without either condition.
- The odds ratio for LF in participants with both CKD and T2DM was 3.50, exceeding the risk with T2DM alone (1.66) or CKD alone (1.38).
- The increased LF risk in patients with both conditions was consistent across demographic and clinical subgroups, suggesting an additive or synergistic effect on liver scarring.
According to the authors, the results carry significant clinical implications. While MASLD is increasingly recognized as a complication of metabolic disorders, liver fibrosis is a more advanced stage of liver damage that can progress to cirrhosis and liver failure. The study’s findings emphasize the importance of routine liver health assessment in people with both diabetes and kidney disease.
Given that transient elastography can detect early fibrosis more reliably than blood-based methods, the researchers advocate for its wider use in at-risk groups. Early detection could enable timely lifestyle interventions, tighter blood sugar and blood pressure control, and possibly drug therapies to slow or prevent progression to advanced liver disease.
"In short, while T2DM alone already places patients at a heightened risk for fatty liver disease, the coexistence of CKD markedly amplifies the danger of significant liver scarring—making vigilant monitoring a medical priority," the authors concluded.
Reference:
Xu, T., & Zhu, W. (2025). Association of chronic kidney disease and type 2 diabetes mellitus with metabolic dysfunction-associated steatotic liver disease and liver fibrosis assessed by transient elastography: A cross-sectional study based on NHANES 2017–2020. Diabetes Research and Clinical Practice, 227, 112418. https://doi.org/10.1016/j.diabres.2025.112418
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