What is the treatment of fatty liver and who is having dialysis and feeling weak

Management of fatty liver disease (NAFLD) in patients undergoing dialysis who are experiencing weakness should focus on comprehensive assessment and supportive care tailored to their complex condition.

Firstly, confirm the diagnosis of NAFLD and exclude other causes of liver disease, as well as assess the risk of advanced liver fibrosis using non-invasive tests such as ELF, NFS, or FIB-4 if feasible. Referral to hepatology specialist is recommended if advanced fibrosis or uncertainty exists ¹,².

In dialysis patients, weakness may be multifactorial, including effects of chronic kidney disease, dialysis-related factors, and liver disease. Addressing reversible causes such as nutritional deficiencies (e.g., thiamine deficiency) is important; parenteral thiamine should be considered if Wernicke’s encephalopathy is suspected ³.

Lifestyle modification remains the cornerstone of NAFLD management, including advice on diet and physical activity. However, in dialysis patients, exercise tolerance may be limited, so tailored, moderate-intensity physical activity should be encouraged as tolerated ¹,².

Weight loss is beneficial in NAFLD but must be cautiously approached in dialysis patients to avoid malnutrition. A Mediterranean diet and avoidance of excess alcohol within national guidelines are advised ¹.

Optimal management of associated metabolic conditions such as hypertension, diabetes, and hyperlipidaemia is essential, with continuation of statins if prescribed, as they are safe in NAFLD and may improve liver outcomes ¹.

Pharmacological treatments for NAFLD (pioglitazone, vitamin E) are reserved for secondary or tertiary care and require specialist oversight; these may be contraindicated or used cautiously in dialysis patients due to comorbidities ¹,².

Overall, management should be multidisciplinary, involving nephrology, hepatology, dietetics, and physiotherapy to address both liver disease and dialysis-related factors contributing to weakness.