JHEP Reports · Oct 26, 2026

Risk of Adverse Kidney Outcomes in Families with MASLD: A Population-Based Multigenerational Cohort Study

By Ebrahimi F, Eichhorn C, Sun J et al.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with chronic kidney disease (CKD), but whether the CKD excess risk extends to MASLD family members is unknown. METHODS: Nationwide multigenerational cohort study involving family members of all Swedish adults with biopsy-proven MASLD (1969-2017) and matched general population comparators. In total, 37,250 MASLD first-degree relatives (FDRs: parents, siblings, offspring) and 9,159 MASLD spouses, as well as 194,327 comparator FDRs and 46,582 comparator spouses were followed until 2021. The primary endpoint was a composite of chronic kidney disease (CKD) diagnosis, kidney failure with replacement therapy (KFRT), or death from CKD. Cox regression was used to calculate adjusted hazard ratios (aHRs). RESULTS: Over a median of 18.8 years, the incidence rate of the composite adverse kidney outcome was higher in MASLD FDRs vs. comparator FDRs (137 vs. 123/100,000 person years (PYs); aHR=1.11, 95%CI=1.01-1.21). Risk estimates for each single component were increased but did not attain statistical significance: CKD (aHR=1.10, 95%CI=0.99-1.21), KFRT (aHR=1.17, 95%CI=0.96-1.41), and death from CKD (aHR=1.25, 95%CI=0.68-2.30). Risks were most pronounced among siblings (aHR=1.21, 95%CI=1.03-1.42). MASLD spouses also had an increased risk of the primary endpoint (25 vs. 20/100,000PY; aHR=1.12, 95%CI=0.97-1.30). CONCLUSIONS: First degree relatives of individuals with biopsy-proven metabolic dysfunction-associated steatotic liver disease have a slightly higher risk of adverse kidney outcomes, but absolute risks are low and do not motivate systematic screening. A similar risk increase in spouses, albeit statistically non-significant, may be compatible with a contribution of shared lifestyle and metabolic factors, although genetic and environmental influences cannot be definitely disentangled.

doi.org/10.1016/j.jhepr.2026.102070 Open access PubMed 42933690 Populations