The Metabolic Dysfunction-Associated Steatotic Liver Disease-CKD Axis: Intersecting Pathways and Opportunities for Early Intervention.

Chronic kidney disease (CKD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are highly prevalent, overlapping conditions with significant health burdens. CKD affects > 650 million people worldwide and is a leading cause of morbidity and mortality, whereas MASLD affects nearly one-third of adults worldwide and increases risks of cardiovascular disease, kidney disease, and cancer. This review synthesizes epidemiologic and mechanistic evidence linking MASLD and CKD, with attention to clinical implications, screening, and management strategies. Studies consistently demonstrate a higher prevalence of CKD among patients with MASLD, with greater risk in those with advanced disease such as metabolic dysfunction-associated steatohepatitis and fibrosis. Shared mechanisms, including insulin resistance; systemic inflammation; renin-angiotensin-aldosterone system activation; and metabolic risk factors such as obesity, hypertension, and diabetes, contribute to kidney injury in this population. The coexistence of MASLD and CKD underscores the need for multidisciplinary approaches to care. Early identification of CKD in patients with MASLD, combined with aggressive management of metabolic risk factors, may improve outcomes. Further research is needed to refine screening strategies, clarify pathophysiologic pathways, and optimize treatment for this growing patient population.