Metabolic-associated fatty liver disease in patients undergoing hemodialysis: A cross-sectional study of prevalence and diagnostic accuracy of the triglyceride–glucose index

Khaled Gouda Abdelwahab; Ahmed Esmat  Saleh; Ashraf Amin   Abdelaziz; Mohammad Almohamady  Khaskia

doi:10.31450/ukrjnd.3(91).2026.03

Khaled Gouda Abdelwahab Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt https://orcid.org/0009-0004-1341-551X
Ahmed Esmat Saleh Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt https://orcid.org/0009-0006-2723-2516
Ashraf Amin Abdelaziz Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt https://orcid.org/0009-0000-0081-1784
Mohammad Almohamady Khaskia Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt https://orcid.org/0000-0002-5193-8387

DOI: https://doi.org/10.31450/ukrjnd.3(91).2026.03

Keywords: fatty liver, triglyceride-glucose index, insulin resistance, end-stage kidney disease, hemodialysis, liver fibrosis

Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly recognized in patients with metabolic and renal disorders; however, data in hemodialysis populations remain limited. This study assessed the prevalence of MAFLD in patients receiving maintenance HD and identified factors associated with its presence.

Methods. A total of 95 patients with end-stage kidney disease (ESKD) receiving maintenance HD were included in this cross-sectional study conducted at Ain Shams University Hospital from January to September 2024. Clinical assessment, abdominal ultrasonography, and laboratory investigations were performed. The triglyceride-glucose (TyG) index, non-alcoholic fatty liver disease (NAFLD) fibrosis score, and fibrosis-4 (FIB-4) score were calculated.

Results. MAFLD was identified in 21 of 95 patients (22.1%). Compared with patients without MAFLD, those with MAFLD had significantly higher body mass index (35.14 ± 3.09 vs. 25.51 ± 4.74 kg/m²), WC (116.95 ± 6.74 vs. 100.24 ± 9.56 cm), CRP (20.38 ± 5.24 vs. 4.59 ± 2.49 mg/L), ALT, AST, TC, LDL-C, triglycerides, TyG index (9.20 ± 0.34 vs. 8.63 ± 0.27), NAFLD fibrosis score, and FIB-4 score (all P < 0.05). Hemoglobin and albumin were substantially lower in the MAFLD group. The TyG index showed high discrimination for MAFLD, with an AUC of 0.906 (95% CI, 0.815–0.998); at a cutoff >8.88, sensitivity was 95.2% and specificity was 82.4%.

Conclusions. MAFLD is common among patients receiving hemodialysis and is associated with metabolic and inflammatory disturbances. The TyG index showed promising discriminative performance for identifying MAFLD in this population. However, the findings are exploratory and require validation in larger, multicenter studies.