Title: Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study
Version: 2 Date: 19 May 2022
Reviewer's report:
NAFLD and CKD become a major public health issue related with their worldwide increasing
prevalence and incidence, poor outcomes and high costs. They often occur alongside with
metabolic conditions, like type 2 diabetes or metabolic syndrome, and are considered a major risk
factors for cardiovascular disease. However, is still a matter of debate what is the real direction
of the association between NAFLD and CKD, or if they only share common risk factors.
With this work, the authors aimed to correlate serum creatinine levels, with hepatic steatosis
(HS), and hepatic fibrosis, according to FIB-4. This is an important issue, with growing interest
and relevance, in the field of NAFLD.
However, there are a few points that should be addressed.
1) The authors correlated the serum creatinine levels with HS, but Glomerular Filtration Rate
(GFR), usually estimated by accessible formulas, is preferable over serum creatinine to evaluate
renal function namely in the early phases of renal damage, and serum creatinine, is very
dependent of muscle mass. Did the authors considered to use GFR values, as most of the
participants had serum creatinine values in the normal range (under 0,9 mg/dl)?
2) Also, the authors grouped in the 4th quartile, all the serum creatinine values above the upper
limit of normal. Is not known, how many of them were close to that limit, and how many
were clearly in renal insufficiency with high serum creatinine values, and if that difference was
accompanied with any differences in HS prevalence.
3) It would be important to know from past medical history, if any of the participants, had already
a previous diagnose of CKD, or were taking any drugs, that could affect the serum creatinine
and renal function.
4) As alcohol consumption can accelerate HS prevalence and hepatic fibrosis, it would be
interesting to know how many of the participants, mainly with HS, had alcohol consumption, in
what amounts, and if that was reflected in serum creatinine.
5) The authors used abdominal ultrasound to define the presence, or absence of HS, like most of
the published population studies, but didn´t mentioned what classification was used, to confirm
the presence of HS.
6) In page 2, line 35 (Abstract/Results), in the phrase “non-HS group (73.19±15.14 vs.
71.75±17.49, p<0.001)”, its suggested to mention the serum creatine units in the text.
Title: Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study
Version: 2 Date: 19 May 2022
Reviewer's report:
NAFLD and CKD become a major public health issue related with their worldwide increasing
prevalence and incidence, poor outcomes and high costs. They often occur alongside with
metabolic conditions, like type 2 diabetes or metabolic syndrome, and are considered a major risk
factors for cardiovascular disease. However, is still a matter of debate what is the real direction
of the association between NAFLD and CKD, or if they only share common risk factors.
With this work, the authors aimed to correlate serum creatinine levels, with hepatic steatosis
(HS), and hepatic fibrosis, according to FIB-4. This is an important issue, with growing interest
and relevance, in the field of NAFLD.
However, there are a few points that should be addressed.
1) The authors correlated the serum creatinine levels with HS, but Glomerular Filtration Rate
(GFR), usually estimated by accessible formulas, is preferable over serum creatinine to evaluate
renal function namely in the early phases of renal damage, and serum creatinine, is very
dependent of muscle mass. Did the authors considered to use GFR values, as most of the
participants had serum creatinine values in the normal range (under 0,9 mg/dl)?
2) Also, the authors grouped in the 4th quartile, all the serum creatinine values above the upper
limit of normal. Is not known, how many of them were close to that limit, and how many
were clearly in renal insufficiency with high serum creatinine values, and if that difference was
accompanied with any differences in HS prevalence.
3) It would be important to know from past medical history, if any of the participants, had already
a previous diagnose of CKD, or were taking any drugs, that could affect the serum creatinine
and renal function.
4) As alcohol consumption can accelerate HS prevalence and hepatic fibrosis, it would be
interesting to know how many of the participants, mainly with HS, had alcohol consumption, in
what amounts, and if that was reflected in serum creatinine.
5) The authors used abdominal ultrasound to define the presence, or absence of HS, like most of
the published population studies, but didn´t mentioned what classification was used, to confirm
the presence of HS.
6) In page 2, line 35 (Abstract/Results), in the phrase “non-HS group (73.19±15.14 vs.
71.75±17.49, p<0.001)”, its suggested to mention the serum creatine units in the text.
Please review this paper.
user
Title: Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study
Version: 2 Date: 19 May 2022
Reviewer's report:
NAFLD and CKD become a major public health issue related with their worldwide increasing
prevalence and incidence, poor outcomes and high costs. They often occur alongside with
metabolic conditions, like type 2 diabetes or metabolic syndrome, and are considered a major risk
factors for cardiovascular disease. However, is still a matter of debate what is the real direction
of the association between NAFLD and CKD, or if they only share common risk factors.
With this work, the authors aimed to correlate serum creatinine levels, with hepatic steatosis
(HS), and hepatic fibrosis, according to FIB-4. This is an important issue, with growing interest
and relevance, in the field of NAFLD.
However, there are a few points that should be addressed.
1) The authors correlated the serum creatinine levels with HS, but Glomerular Filtration Rate
(GFR), usually estimated by accessible formulas, is preferable over serum creatinine to evaluate
renal function namely in the early phases of renal damage, and serum creatinine, is very
dependent of muscle mass. Did the authors considered to use GFR values, as most of the
participants had serum creatinine values in the normal range (under 0,9 mg/dl)?
2) Also, the authors grouped in the 4th quartile, all the serum creatinine values above the upper
limit of normal. Is not known, how many of them were close to that limit, and how many
were clearly in renal insufficiency with high serum creatinine values, and if that difference was
accompanied with any differences in HS prevalence.
3) It would be important to know from past medical history, if any of the participants, had already
a previous diagnose of CKD, or were taking any drugs, that could affect the serum creatinine
and renal function.
4) As alcohol consumption can accelerate HS prevalence and hepatic fibrosis, it would be
interesting to know how many of the participants, mainly with HS, had alcohol consumption, in
what amounts, and if that was reflected in serum creatinine.
5) The authors used abdominal ultrasound to define the presence, or absence of HS, like most of
the published population studies, but didn´t mentioned what classification was used, to confirm
the presence of HS.
6) In page 2, line 35 (Abstract/Results), in the phrase “non-HS group (73.19±15.14 vs.
71.75±17.49, p<0.001)”, its suggested to mention the serum creatine units in the text.
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