Metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) are interconnected components of the cardiovascular-kidney-metabolic (CKM) continuum. This brief review focuses on kidney involvement as a major risk modifier and prognostic factor in patients with MASLD. It reviews epidemiological data, shared pathophysiological mechanisms, and non-invasive approaches to risk stratification: estimated glomerular filtration rate (eGFR) and the urinary albumin-to-creatinine ratio (UACR) for kidney function, and the FIB-4 index and elastography for liver fibrosis. Phenotype-directed therapeutic strategies are discussed, including SGLT2 inhibitors, GLP-1 receptor agonists, renin–angiotensin–aldosterone system (RAAS) blockers, finerenone, and liver-directed therapies.
Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-86. doi:10.1097/HEP.0000000000000520.
European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi:10.1016/j.jhep.2024.04.031.
Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606-35. doi:10.1161/CIR.0000000000001184.
Zhou XD, Zheng MH. Cardiovascular-kidney-metabolic syndrome and MASLD: integrating medical perspectives. Nat Rev Cardiol. 2025;22(11):843. doi:10.1038/s41569-025-01199-y.
Angelidi AM, Boutari C, Kokkorakis M, Stefanakis K, Mikhailidis DP, Jacob G, et al. MASLD and the cardiovascular-kidney-liver-metabolic syndrome. Endocr Rev. 2026 Jul 15:bnag023. doi:10.1210/endrev/bnag023.
Kueh MTW, Yeo JKW, Chen Y, Chua NYZ, Koh HL, Khaw SP, et al. Global prevalence, incidence, and outcomes of coexisting MASLD and chronic kidney disease: a meta-analysis. Liver Int. 2026;46(7):e70747. doi:10.1111/liv.70747.
Sethasine S, Trakarnvanich T, Ruamtawee W, Treerasoradaj N, Susantitaphong P. Association of noninvasive tests of liver fibrosis with chronic kidney disease in MASLD: a systematic review and meta-analysis. Sci Rep. 2025;15:42681. doi:10.1038/s41598-025-26752-0.
Mantovani A, Csermely A, Petracca G, Beatrice G, Corey KE, Simon TG, et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(11):903-13. doi:10.1016/S2468-1253(21)00308-3.
Mantovani A, Morandin R, Sani E, Fiorio V, Shtembari E, Bonapace S, et al. MASLD is associated with an increased long-term risk of atrial fibrillation: an updated systematic review and meta-analysis. Liver Int. 2025;45(1):e16218. doi:10.1111/liv.16218.
Bolignano D, Lacquaniti A, Coppolino G, Campo S, Arena A, Buemi M. Neutrophil gelatinase-associated lipocalin reflects the severity of renal impairment in subjects affected by chronic kidney disease. Kidney Blood Press Res. 2008;31(4):255-8. doi:10.1159/000143726.
Guo L, Zhao Y, Yong Z, Zhao W. Evaluation value of neutrophil gelatinase-associated lipocalin for the renal dysfunction of patients with chronic kidney disease: a meta-analysis. Aging Med (Milton). 2018;1(2):185-96. doi:10.1002/agm2.12033.
Xu D, Zhang Z, Zhu Z, Wei W, Bai Y, Wang W, et al. Decreased LONP1 expression exacerbates MASH-induced liver fibrosis via elevated orotic acid levels. J Hepatol. 2026;84(1):165-80. doi:10.1016/j.jhep.2025.07.013.
Harrison SA, Bedossa P, Guy CD, Schattenberg JM, Loomba R, Taub R, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med. 2024;390(6):497-509. doi:10.1056/NEJMoa2309000.
Loomba R, Hartman ML, Lawitz EJ, Vuppalanchi R, Boursier J, Bugianesi E, et al. Tirzepatide for metabolic dysfunction-associated steatohepatitis with liver fibrosis. N Engl J Med. 2024;391(4):299-310. doi:10.1056/NEJMoa2401943.
Sanyal AJ, Newsome PN, Kliers I, Harms Østergaard L, Long MT, Skalshøi Kjær M, et al.; ESSENCE Study Group. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis. N Engl J Med. 2025;392(21):2089-99. doi:10.1056/NEJMoa2413258.
Taylor RS, Taylor RJ, Bayliss S, Hagstrom H, Nasr P, Schattenberg JM, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Gastroenterology. 2020;158(6):1611-25.e12. doi:10.1053/j.gastro.2020.01.043.
Mantovani A, Petracca G, Beatrice G, Csermely A, Lonardo A, Schattenberg JM, et al. Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: an updated meta-analysis. Gut. 2022;71(1):156-62. doi:10.1136/gutjnl-2020-323082.
Mantovani A, Petracca G, Csermely A, Beatrice G, Bonapace S, Rossi A, et al. Non-alcoholic fatty liver disease and risk of new-onset heart failure: an updated meta-analysis of about 11 million individuals. Gut. 2023;72(2):372-80. doi:10.1136/gutjnl-2022-327672.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4 Suppl):S117-314. doi:10.1016/j.kint.2023.10.018.
Suassuna PGA, de Paula RB, Sanders-Pinheiro H, Moe OW, Hu MC. Fibroblast growth factor 21 in chronic kidney disease. J Nephrol. 2019;32(3):365-77. doi:10.1007/s40620-018-0550-y.
Salgado JV, Goes MA, Salgado Filho N. FGF21 and chronic kidney disease. Metabolism. 2021;118:154738. doi:10.1016/j.metabol.2021.154738.
Heerspink HJL, Stefansson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383(15):1436-46. doi:10.1056/NEJMoa2024816.
The EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388(2):117-27. doi:10.1056/NEJMoa2204233.
Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al.; SELECT Trial Investigators. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-32. doi:10.1056/NEJMoa2307563.
Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, et al.; FLOW Trial Committees and Investigators. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391(2):109-21. doi:10.1056/NEJMoa2403347.
Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al.; FIDELIO-DKD Investigators. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383(23):2219-29. doi:10.1056/NEJMoa2025845.
Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al.; FIGARO-DKD Investigators. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med. 2021;385(24):2252-63. doi:10.1056/NEJMoa2110956.
Agarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43(6):474-84. doi:10.1093/eurheartj/ehab777.
