Clinical and Molecular Hepatology

"Chronic kidney disease"

Correspondence

Incorporating chronic kidney disease into the cost-effectiveness of MASLD treatment: Eileen L. Yoon, Jeong-Yeon Cho, Mimi Kim, Huiyul Park, Hye-Lin Kim, Dae Won Jun; Received January 20, 2026 Accepted January 24, 2026 Published online February 2, 2026; DOI: https://doi.org/10.3350/cmh.2026.0099 [Accepted]

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Review

Tracking the trajectory of kidney dysfunction in cirrhosis: the acute kidney injury: chronic kidney disease spectrum: Vishnu Girish, Rakhi Maiwall; Clin Mol Hepatol 2025;31(3):730-752.
Published online March 26, 2025; DOI: https://doi.org/10.3350/cmh.2024.1060

Abstract
PDF

Kidney disease in cirrhosis is now viewed as a continuum encompassing acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD), rather than three different disorders. Contemporary diagnostic criteria for AKI integrate urine output (UO) parameters and acknowledge the intricate relationship and possibility of overlap between functional and structural as well as acute and chronic entities, including hepatorenal syndrome (HRS). AKI demonstrates a propensity for progression to AKD and CKD, particularly in the context of recurrent and severe insults. The diagnostic complexity is further compounded by limitations in serum creatinine measurements, prompting the integration of novel biomarkers and the need to accurately estimate glomerular filtration rate. The diagnosis, phenotyping, and management of AKI should be prompt and early; the initial step should always be volume and UO assessment. A personalized approach is needed and the possibility of co-existing structural or functional kidney disease should be borne in mind. The earlier concept of waiting for 48 hours to diagnose HRS has evolved and early diagnosis and prompt treatment are advised now. Kidney replacement therapy and simultaneous liver and kidney transplantation may be required in resistant cases.

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Comprehensive Conservative Management Versus Dialysis in Uric Acid Control
Francesca K. Martino, Greta Redi, Marco Bogo, Elena Sgrò, Alessandra Zattarin, Giovanni Samassa, Lucia Federica Stefanelli, Anna Basso, Federico Nalesso
Dietetics.2026; 5(1): 9. CrossRef
Association between the C-reactive protein–triglyceride–glucose index (CTI) and the risk of acute kidney injury in critically ill patients with cirrhosis
Lu-Huai Feng, Tianbao Liao, Tingting Su, Xuefei Zhou, Yang Lu, Lina Huang, Zhenhua Yang
BMC Nephrology.2025;[Epub] CrossRef

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Correspondences

Liver Transplantation

Correspondence to editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Soon Kyu Lee, Jong Young Choi; Clin Mol Hepatol 2025;31(2):e161-e162.
Published online February 13, 2025; DOI: https://doi.org/10.3350/cmh.2025.0121

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Liver Transplantation

Correspondence to letter to the editor on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Soon Kyu Lee, Jong Young Choi; Clin Mol Hepatol 2025;31(2):e212-e214.
Published online February 10, 2025; DOI: https://doi.org/10.3350/cmh.2025.0100

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Editorial

Liver Transplantation

Intrapatient variability of tacrolimus trough level may be not the cause, but an indirect parameter of comorbidities: Editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Jongman Kim; Clin Mol Hepatol 2025;31(2):589-591.
Published online January 24, 2025; DOI: https://doi.org/10.3350/cmh.2025.0076

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Correspondence to editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”
Soon Kyu Lee, Jong Young Choi
Clinical and Molecular Hepatology.2025; 31(2): e161. CrossRef

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Letter to the Editor

Liver Transplantation

Tacrolimus levels and variability in CKD and ESRD risk post-liver transplant: Letter to the editor on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Rui Shi, Minghua Wang; Clin Mol Hepatol 2025;31(2):e137-e139.
Published online January 9, 2025; DOI: https://doi.org/10.3350/cmh.2024.1159

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Correspondence to letter to the editor on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”
Soon Kyu Lee, Jong Young Choi
Clinical and Molecular Hepatology.2025; 31(2): e212. CrossRef

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Review

Steatotic liver disease

Bioactive metabolites: A clue to the link between MASLD and CKD?: Wen-Ying Chen, Jia-Hui Zhang, Li-Li Chen, Christopher D. Byrne, Giovanni Targher, Liang Luo, Yan Ni, Ming-Hua Zheng, Dan-Qin Sun; Clin Mol Hepatol 2025;31(1):56-73.
Published online October 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0782

Metabolites produced as intermediaries or end-products of microbial metabolism provide crucial signals for health and diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD). These metabolites include products of the bacterial metabolism of dietary substrates, modification of host molecules (such as bile acids [BAs], trimethylamine-N-oxide, and short-chain fatty acids), or products directly derived from bacteria. Recent studies have provided new insights into the association between MASLD and the risk of developing chronic kidney disease (CKD). Furthermore, alterations in microbiota composition and metabolite profiles, notably altered BAs, have been described in studies investigating the association between MASLD and the risk of CKD. This narrative review discusses alterations of specific classes of metabolites, BAs, fructose, vitamin D, and microbiota composition that may be implicated in the link between MASLD and CKD.

Citations

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Radish Green Extract Attenuates Western Diet-Induced Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease in Mice
Hye-Bin Lee, Yu Ra Lee, Eunjung Lee, Seong Un Jeong, Jae-Hyun Yoon, Miri Park, Yoonsook Kim, Ho-Young Park
Journal of Agricultural and Food Chemistry.2026; 74(1): 874. CrossRef
Multi-omics reveal the key role of gut microbiota metabolism in adenine-induced chronic kidney disease
Yijing Xin, Hui Ma, Xiang Li, Ruiyang Sun, Luo Fang, Libin Pan
Toxicology and Applied Pharmacology.2026; 509: 117754. CrossRef
Liver-Kidney Crosstalk in Major Pediatric Diseases: Unraveling the Complexities and Clinical Challenges
Dario Piatto, Delia De Biasio, Francesco Giustino Cesaro, Gianmario Forcina, Vittoria Frattolillo, Antonio Colucci, Fabio Lamberti, Pierluigi Marzuillo, Emanuele Miraglia del Giudice, Anna Di Sessa
Journal of Clinical Medicine.2025; 14(11): 3911. CrossRef
Altered mitochondrial function: a clue therapeutic strategies between metabolic dysfunction-associated steatotic liver disease and chronic kidney disease?
Jiang Bai, Lijuan Zhang, Letian He, Yun Zhou
Frontiers in Nutrition.2025;[Epub] CrossRef
Food Nutrients and Bioactive Compounds for Managing Metabolic Dysfunction-Associated Steatotic Liver Disease: A Comprehensive Review
Erdenetsogt Dungubat, Kohei Fujikura, Masahiko Kuroda, Toshio Fukusato, Yoshihisa Takahashi
Nutrients.2025; 17(13): 2211. CrossRef
Quyu Huazhuo Decoction alleviates non-Alcoholic steatohepatitis via remodeling the gut microbiota and regulating bile acid and short-chain fatty acid metabolism
Lu Lu, Chengting Wu, Juhong Jia, Yuanqin Du, Yujiao Peng, Hongna Huang, Jingjing Huang, Yaobin Nong
Journal of Chromatography B.2025; 1267: 124784. CrossRef
The transition from NAFLD to MASLD: implications for Diagnosis, Prognosis, and Clinical Management
Carlo Acierno, Riccardo Nevola, Fannia Barletta, Katarzyna Zielińska, Luca Rinaldi, Ferdinando Carlo Sasso, Caterina Conte, Luigi Elio Adinolfi, Alfredo Caturano
Exploration of Medicine.2025;[Epub] CrossRef
Multiorgan crosstalk in MASLD/MASH: from hepatic pathogenesis to systemic complications
Wenhua Bai, Zheng Zhu
Frontiers in Endocrinology.2025;[Epub] CrossRef
Metabolic Dysfunction-Associated Steatotic Liver Disease and Liver Fibrosis are Associated with Advanced Cardiovascular-Kidney-Metabolic Syndrome in Chinese and US Populations
Shidi Hu, Dongmei Wang, Qingtao Yu, Zhi Chen, Weiguo Lu, Yuan Meng, Xuetao Peng, Lan Liu, Heng Wan, Jie Shen
Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 4699. CrossRef

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Original Article

Liver Transplantation

Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation: Soon Kyu Lee, Ho Joong Choi, Young Kyoung You, Pil Soo Sung, Seung Kew Yoon, Jeong Won Jang, Jong Young Choi; Clin Mol Hepatol 2025;31(1):131-146.
Published online October 2, 2024; DOI: https://doi.org/10.3350/cmh.2024.0451

Background/Aims
This study aimed to identify the risk factors for chronic kidney disease (CKD) and end-stage renal disease (ESRD) following liver transplantation (LT), with a specific focus on tacrolimus levels and intrapatient variability (IPV).
Methods
Among the 1,076 patients who underwent LT between 2000 and 2018, 952 were included in the analysis. The tacrolimus doses and levels were recorded every 3 months, and the IPV was calculated using the coefficient of variability. The cumulative incidence rates of CKD and ESRD were calculated based on baseline kidney function at the time of LT. The impact of tacrolimus levels and their IPV on the development of CKD and ESRD was evaluated, and the significant risk factors were identified.
Results
Within a median follow-up of 97.3 months, the 5-year cumulative incidence rates of CKD (0.58 vs. 0.24) and ESRD (0.07 vs. 0.01) were significantly higher in the acute kidney injury group than in the normal glomerular filtration rate (GFR) group. In the normal GFR group, the tacrolimus levels were identified as a risk factor for CKD, with a level of ≤4.5 ng/mL suggested as optimal for minimizing the risk of CKD. Furthermore, the IPV of tacrolimus levels and doses emerged as a significant risk factor for CKD development in both groups (p<0.05), with tenofovir disoproxil fumarate also being a risk factor in HBV-infected patients. The IPV of tacrolimus levels was also a significant factor in ESRD development (p<0.05).
Conclusions
This study elucidated the optimal tacrolimus trough level and highlighted the impact of IPV on the CKD and ESRD development post-LT.

Citations

Citations to this article as recorded by

Intrapatient variability of tacrolimus trough level may be not the cause, but an indirect parameter of comorbidities: Editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development foll
Jongman Kim
Clinical and Molecular Hepatology.2025; 31(2): 589. CrossRef
Correspondence to letter to the editor on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”
Soon Kyu Lee, Jong Young Choi
Clinical and Molecular Hepatology.2025; 31(2): e212. CrossRef
Clinical significance and gene prediction of a novel classification system based on tacrolimus concentration-to-dose ratio in the early post-liver transplant period
Junwei Fan, Peihao Wen, Liyun Yuan, Yan Xia, Shijie Hu, Xiaoqing Zhang, Zhihai Peng
Frontiers in Pharmacology.2025;[Epub] CrossRef
Chronic kidney disease at one year after liver transplantation: Role of changes in immunosuppression over three decades
Alejandro Muñoz-Serrano, María Jesús Citores, Andrea Gutiérrez-Villanueva, Víctor Moreno-Torres, Jorge V López-Ibor, Natalia Vicente, Valentín Cuervas-Mons
World Journal of Transplantation.2025;[Epub] CrossRef

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Letter to the Editor

Steatotic liver disease

Equivalent prevalence and progression of chronic kidney disease in non-alcoholic fatty liver disease and metabolic dysfunction-associated steatotic liver disease: Hiroyuki Suzuki, Tsubasa Tsutsumi, Machiko Kawaguchi, Keisuke Amano, Takumi Kawaguchi; Clin Mol Hepatol 2024;30(4):962-964.
Published online May 20, 2024; DOI: https://doi.org/10.3350/cmh.2024.0264

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Metabolic dysfunction‐associated steatotic liver disease (SLD) and alcohol‐associated liver disease, but not SLD without metabolic dysfunction, are independently associated with new onset of chronic kidney disease during a 10‐year follow‐up period
Kazuma Mori, Marenao Tanaka, Tatsuya Sato, Yukinori Akiyama, Keisuke Endo, Toshifumi Ogawa, Toru Suzuki, Hiroki Aida, Wataru Kawaharata, Kei Nakata, Itaru Hosaka, Araya Umetsu, Nagisa Hanawa, Masato Furuhashi
Hepatology Research.2025; 55(1): 34. CrossRef
Metabolic dysfunction-associated steatotic liver disease and risk of four intrahepatic and extrahepatic diseases
Yiyuan Xiao, Sihua Xu, Wenyan Hu, Jiapeng Huang, Deke Jiang, Rong Na, Zhaoqing Yin, Jingjing Zhang, Haitao Chen
Annals of Hepatology.2025; 30(1): 101750. CrossRef
Chronic Kidney Disease Risk Associated With Metabolic Dysfunction‐Associated Steatotic Liver Disease: A Nationwide Cohort Study in Korea
Dong Wook Kim, Minkook Son, Hye Jung Lee, Chi Hyeon Choi, Yeo Wool Kang, Sang Yi Moon, Myeongseok Koh, Jong Yoon Lee, Yang Hyun Baek, Won Suk An
Hepatology Research.2025; 55(9): 1239. CrossRef
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Scientific Reports.2024;[Epub] CrossRef
Pemafibrate Reduced Liver Stiffness in Patients with Metabolic Dysfunction-associated Steatotic Liver Disease Complicated with Hyperlipidemia and Liver Fibrosis with a Fibrosis-4 Index Above 1.3
Tatsuki Ichikawa, Mio Yamashima, Shinobu Yamamichi, Makiko Koike, Yusuke Nakano, Hiroyuki Yajima, Osamu Miyazaki, Tomonari Ikeda, Takuma Okamura, Naohiro Komatsu, Sayuri Sugio, Miruki Yoshino, Hisamitsu Miyaaki
Internal Medicine.2024;[Epub] CrossRef

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Editorial

Viral hepatitis

Use of sofosbuvir in chronic kidney disease: Is it necessary?: Tae Seop Lim, Sang Hoon Ahn; Clin Mol Hepatol 2017;23(4):308-310.
Published online September 26, 2017; DOI: https://doi.org/10.3350/cmh.2017.0109

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Assessment of Renal Function in Egyptian HCV Patients Treated with Combination Therapy of Sofosbuvir and Daclatasvir
Hala Abd El Maguid, Ahmed Heiba, Enass El Sayed, Hazem El-Hariri, Haythem Tolba, Muhammad Abdel Ghaffar
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Canadian Journal of Gastroenterology and Hepatology.2020; 2020: 1. CrossRef
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Guglielmo Borgia, Riccardo Scotto, Antonio Riccardo Buonomo
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Clinical and Molecular Hepatology.2017; 23(4): 314. CrossRef

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Original Articles

Viral hepatitis

Efficacy and safety of sofosbuvir-based regimens for treatment in chronic hepatitis C genotype 1 patients with moderately impaired renal function: Hyun Phil Shin, Ji-Ae Park, Blaire Burman, Richard A. Kozarek, Asma Siddique; Clin Mol Hepatol 2017;23(4):316-322.
Published online August 22, 2017; DOI: https://doi.org/10.3350/cmh.2016.0087

Abstract
PDF

Background/Aims
Treatment of chronic hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) is essential. The availability of sofosbuvir (SOF) has dramatically improved overall HCV cure rates, however there is insufficient data regarding its use in patients with CKD. We evaluated SOF in patients with hepatitis C genotype 1 (G1) and moderately impaired renal function.
Methods
We retrospectively reviewed all patients treated with a SOF-based regimen from December 2013 through September 2015 at Virginia Mason Medical Center. Data was then collected for HCV G1 patients with stage 3 CKD.
Results
A total of 28 patients with HCV G1 and stage 3 CKD were treated with a SOF-based regimen. Twenty-one patients had stage 3A CKD (estimated glomerular filtration rate [eGFR] 45–60 mL/min/1.73m²) and 7 patients had stage 3B CKD (eGFR 30–45 mL/min/1.73m²). The overall rate of sustained virologic response (SVR) 12 weeks after completion of therapy (SVR12) was 85.7% (24/28). SVR12 in stage 3A CKD patients was 81.0% (17/21) and in stage 3B CKD patients, SVR12 was 100% (7/7). Based on the treatment regimen used, the SVR12 was 81.8% (9/11), 92.3% (12/13), and 75.0% (3/4) for SOF/ledipasvir (LDV), SOF/simeprevir (SIM), and SOF/pegylated interferon (PEG)/ribavirin (RBV), respectively. Greater than 30% reduction eGFR was observed in 5 out of 28 patients.
Conclusions
SOF-based regimens resulted in high SVR12 rates in patients with moderately impaired renal function. During therapy, HCV patients with CKD should be carefully monitored for worsening renal function.

Citations

Citations to this article as recorded by

Assessment of Renal Function in Egyptian HCV Patients Treated with Combination Therapy of Sofosbuvir and Daclatasvir
Hala Abd El Maguid, Ahmed Heiba, Enass El Sayed, Hazem El-Hariri, Haythem Tolba, Muhammad Abdel Ghaffar
Open Access Macedonian Journal of Medical Sciences.2022; 10(B): 82. CrossRef
Efficacy and safety of direct‐acting antiviral therapy for hepatitis C virus in elderly patients (≥65 years old): A systematic review and meta‐analysis
Jieun Lee, Sang Bong Ahn, Sun Young Yim, Jihyun An, Dae Won Jun, Min Jung Ko, Dong Ah Park, Jeong‐Ju Yoo
Journal of Viral Hepatitis.2022; 29(7): 496. CrossRef
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W. Fadili, A. Ait Errami, S. Zaoui, K. Elkassimi, N. ElBouhi, S. Oubaha, Z. Samlani, I. Laouad, K. Krati
European Journal of Medical and Health Sciences.2021; 3(1): 160. CrossRef
Efficacy and safety of direct-acting antiviral agents for HCV in mild-to-moderate chronic kidney disease
Ezequiel Ridruejo, Rebeca Garcia-Agudo, Manuel Mendizabal, Sami Aoufi-Rabih, Vivek Dixit, Marcelo Silva, Fabrizio Fabrizi
Nefrología.2020; 40(1): 46. CrossRef
Sofosbuvir‐containing regimens are safe and effective in the treatment of HCV patients with moderate to severe renal impairment
Rasha Eletreby, Magdy El‐Serafy, Mahmoud Anees, Gamal Kasem, Marwa Salama, Reham Elkhouly, Mostafa Hamdy, Hisham Abdel Haleem, Ehab Kamal, Wael Abdel‐Razek, Rabab Salama, Mohamed Elshenawy, Ayman Shafeek, Mohamed Hassany, Manal H. El‐Sayed, Yehia El‐Shazl
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Ezequiel Ridruejo, Rebeca Garcia-Agudo, Manuel Mendizabal, Sami Aoufi-Rabih, Vivek Dixit, Marcelo Silva, Fabrizio Fabrizi
Nefrología (English Edition).2020; 40(1): 46. CrossRef
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Shao-Ming Chiu, Ming-Chao Tsai, Chun-Yen Lin, Chien-Hung Chen, Sheng-Nan Lu, Chao-Hung Hung, I-Shyan Sheen, Rong-Nan Chien, Chih-Lang Lin, Tsung-Hui Hu, Yu-Fan Cheng, Chao-Long Chen, Tatsuo Kanda
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Javier Pagan, Marco Ladino, David Roth
Seminars in Dialysis.2019; 32(2): 152. CrossRef
Sofosbuvir

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Use of sofosbuvir in chronic kidney disease: Is it necessary?
Tae Seop Lim, Sang Hoon Ahn
Clinical and Molecular Hepatology.2017; 23(4): 308. CrossRef

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Liver fibrosis, cirrhosis, and portal hypertension

Prevalence of renal dysfunction in patients with cirrhosis according to ADQI-IAC working party proposal: Yun Jung Choi, Jeong Han Kim, Ja Kyung Koo, Cho I Lee, Ji Young Lee, Jae Hoon Yang, Soon Young Ko, Won Hyeok Choe, So Young Kwon, Chang Hong Lee; Clin Mol Hepatol 2014;20(2):185-191.
Published online June 30, 2014; DOI: https://doi.org/10.3350/cmh.2014.20.2.185

Abstract
PDF

Background/Aims

A revised classification system for renal dysfunction in patients with cirrhosis was proposed by the Acute Dialysis Quality Initiative and the International Ascites Club Working Group in 2011. The aim of this study was to determine the prevalence of renal dysfunction according to the criteria in this proposal.

Methods

The medical records of cirrhotic patients who were admitted to Konkuk University Hospital between 2006 and 2010 were reviewed retrospectively. The data obtained at first admission were collected. Acute kidney injury (AKI) and chronic kidney disease (CKD) were defined using the proposed diagnostic criteria of kidney dysfunction in cirrhosis.

Results

Six hundred and forty-three patients were admitted, of whom 190 (29.5%), 273 (42.5%), and 180 (28.0%) were Child-Pugh class A, B, and C, respectively. Eighty-three patients (12.9%) were diagnosed with AKI, the most common cause for which was dehydration (30 patients). Three patients had hepatorenal syndrome type 1 and 26 patients had prerenal-type AKI caused by volume deficiency after variceal bleeding. In addition, 22 patients (3.4%) were diagnosed with CKD, 1 patient with hepatorenal syndrome type 2, and 3 patients (0.5%) with AKI on CKD.

Conclusions

Both AKI and CKD are common among hospitalized cirrhotic patients, and often occur simultaneously (16.8%). The most common type of renal dysfunction was AKI (12.9%). Diagnosis of type 2 hepatorenal syndrome remains difficult. A prospective cohort study is warranted to evaluate the clinical course in cirrhotic patients with renal dysfunction.

Citations

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