Patients receiving dialysis for end-stage kidney disease (ESKD) commonly co-exhibit risk factors for hepatic impairment. This systematic review and meta-analysis aimed to quantify the co-existence of chronic liver disease (CLD) and characterise risk factors and outcomes.

We searched the following databases from inception to May 2021: CINAHL, Cochrane Library, EMBASE, Kings Fund Library, MEDLINE and PubMed. The protocol was pre-registered on PROSPERO (study ID: CRD42020206486). Studies were assessed against three inclusion criteria: (1) adults (>18 years) with ESKD receiving dialysis (2) primary outcome involving CLD prevalence (3) publications in English. Moderator analysis was performed for age, gender, study size, and publication year. Sensitivity analysis was performed where applicable by removing outlier results and studies at high risk of bias.

Searches yielded 7,195 articles, 15 met the inclusion criteria. 320,777 patients were included. Prevalence of cirrhosis and non-alcoholic fatty liver disease (NAFLD) was 5% and 55%, respectively. Individuals with CLD had two-fold higher mortality than those without (OR 2.19; 95% confidence interval 1.39-3.45). Hepatitis B (OR 13.47;1.37-132.55) and hepatitis C (OR 7.05; 4.00-12.45), but not diabetes, conferred increased cirrhosis risk. All studies examining NAFLD were judged to be at high risk of bias. We found no data on non-alcoholic steatohepatitis (NASH). Deaths from CLD, cancer and infection were greater amongst cirrhotic patients.

CLD is prevalent in dialysis patients. Hepatitis B and C confer increased risk of CLD. The impact of NAFLD and NASH cirrhosis requires further study. CLD associates with increased mortality risk in this setting.
Original languageEnglish
Article numbersfab230
Number of pages26
JournalClinical Kidney Journal
Publication statusE-pub ahead of print - 18 Nov 2021


  • dialysis, ESRD, haemodialysis, peritoneal dialysis, systematic review


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