Global Prevalence, Incidence, and Outcomes of Coexisting MASLD and Chronic Kidney Disease: A Meta-Analysis

Background & aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and increasingly recognized as a multisystem cardiometabolic disorder. The global burden, incidence and prognostic implications of coexisting chronic kidney disease (CKD) in MASLD remain uncertain. Methods: In this meta-analysis, we searched MEDLINE and EMBASE from inception through September 25, 2025, for observational studies reporting CKD prevalence and/or incidence among adults (≥ 18 years) with MASLD. The primary outcomes were pooled CKD prevalence, estimated using random-effects models on the logit scale with the Hartung-Knapp adjustment, and pooled CKD incidence (per 1000 person-years), estimated using random-effects models with exact Poisson confidence intervals. Secondary outcomes included all-cause mortality and cardiovascular, renal and cancer outcomes. Results: From 2811 records, 36 observational studies met the inclusion criteria. Twenty-three studies contributed prevalence estimates (575 615 participants; 56 248 CKD cases) and thirteen studies contributed incidence estimates (27 996 new events). The pooled global CKD prevalence among individuals with MASLD was 15.22% (95% CI 9.69-23.12). The pooled CKD incidence was 22.17 per 1000 person-years (95% CI 11.44-32.89) in the MASLD population. Hypertension (OR 1.49, 95% CI 1.29-1.72), dyslipidaemia (OR 1.22, 95% CI 1.20-1.24) and diabetes (OR 1.94, 95% CI 1.69-2.22) were associated with higher odds of CKD in the MASLD population. All-cause mortality rates were 18.28 per 1000 person-years (95% CI 3.45-33.11) in coexistent MASLD and CKD, more than double those in the MASLD-only population (7.26 per 1000 person-years (95% CI 2.97-11.56)). Conclusions: Coexistent CKD affects one in seven individuals with MASLD worldwide, conferring a more than two-fold increased risk of all-cause mortality compared with individuals with MASLD alone.