الفهرس 
Acknowledgments
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Abstract
N on-alcoholic fatty liver disease and chronic kidney disease share mechanistic pathways related to metabolic dysfunction.
Therefore non-alcoholic fatty liver disease is considered a risk factor for the development of chronic kidney disease, independent of potential confounding metabolic factors such as body mass index and diabetes mellitus.
Fatty liver disease and its complications will likely pose an increasing burden among patients with chronic kidney disease due to the increasing prevalence of metabolic syndrome among ultrasound adults. nevertheless, the incidence and predictors of non-alcoholic fatty liver disease among patients with chronic kidney disease are not well described in the literature.
The current study enrolled a total of 80 patients with different stages of chronic kidney disease. The aim of this study was assess prevalence of nonalcoholic liver disease and its risk factors among patients with chronic kidney disease. in addition to, determine the relationship between the severity of fatty liver in nonalcoholic liver disease assessed by liver enzymes and tissue inhibitor of metalloproteinase-1. it was conducted at internal medicine department of assiut university hospital in the period between from March 2020 to March 2021.
Based on the current study, a total of 15 (18.8%) patients with chronic kidney disease had non-alcoholic liver disease while the other 65 (81.2%) patients didn’t have non-alcoholic liver disease. both groups of patients either with or without non-alcoholic liver disease had insignificant differences as regard different demographic data except for patients with non-alcoholic liver disease had significantly higher body mass index.
There are no significant differences between both groups as regard baseline laboratory data with except of patients with non-alcoholic liver disease had significantly higher tissue inhibitor of metalloproteinase-1 . patients with non-alcoholic liver disease had significantly lower glomerular filtration rate (ml/min). also, stages of chronic kidney disease were more advanced in patients with non-alcoholic liver disease. also, non-alcoholic liver disease group had significant difference as regard liver stiffness where majority (84.6%) of patients without non-alcoholic liver disease had f0 and majority (73.3%) of those with non-alcoholic liver disease had f1.
It was found that TIMP-I had insignificant correlations with other variables in the current study with except of positive significant correlation with creatinine and albumin/creatinine ratio with negative significant correlation with estimated glomerular filtration rate.
Based on the current study, predictors for development of non-alcoholic liver disease among patients with chronic kidney disease were; tissue inhibitor of metalloproteinase-1, estimated glomerular filtration rate,more advanced stages of chronic kidney disease and degree of fibrosis. it was found that TIMP-I at cutoff point > 21, has 97.2% accuracy for prediction of non-alcoholic liver disease in patients with chronic kidney disease with area under curve was 0.97 while f1 degree of fibroscan has 89.7% accuracy for prediction of non-alcoholic liver disease in patients with chronic kidney disease with area under curve was 0.91.
In conclusion, non-alcoholic liver fatty disease is fairly common in patients with CKD. Early detection of those patients who are at risk to developed non-alcoholic liver disease may help in improving their outcome. also, tissue inhibitor of metalloproteinase-1is considered as a novel biomarker for early diagnosis of non-alcoholic liver disease among patients with chronic kidney disease. , fibroscan is considered an available effective cheap and non invasive method for assessment of NAFLD severity.