Nonlinear Association Between Liver Stiffiness Measurement and CKD in MASLD: Evidence for eGDR as a Key Mediator

Objective To investigate the association between liver stiffness measurement (LSM) and the prevalence of chronic kidney disease (CKD) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) and to explore the potential mediating role in this relationship. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020. Logistic regression and subgroup analyses were used to evaluate the association between LSM and CKD. To examine potential non-linear associations, we performed logistic regression with restricted cubic splines (RCS), and mediation analysis was performed to explore potential mediation indicators. Results In the fully adjusted model, compared with low LSM levels (< 8.0 kPa), the OR for CKD in individuals with high LSM levels (≥ 8.0 kPa) was 1.68 (95% CI: 1.09–2.60). RCS analysis demonstrated a non-linear dose-response relationship between LSM and CKD risk (P-nonlinearity = 0.01). Furthermore, subgroup analyses indicated that this association was consistent across various demographics and clinical conditions, with no significant interaction by sex, age, BMI, diabetes, hypertension, hs-CRP, or estimated Glucose Disposal Rate (eGDR) levels (all P for interaction > 0.05). Mediation analysis subsequently explored the role of insulin sensitivity. We found that eGDR, an indicator of insulin sensitivity, accounted for 19.55% of the total effect of LSM on CKD (P < 0.001). Conclusion Elevated LSM is an independent risk factor for CKD in individuals with MASLD, and eGDR plays an important role in this process. This conclusion needs to be validated by cohort studies.