Because SLKT, which is now increasing in the US, will result in unacceptably high morbidity and public healthcare costs, a variety of drug pipelines exist for simultaneously treating NASH/NAFLD and diabetic nephropathy/CKD, such as PPAR agonists, FXR agonists, CCR2/5 antagonists, Nrf2 activators, ASK-1 inhibitors, Gal-3 inhibitors and gut microbiome manipulation. This evidence concerns the gene NR1H4 and metabolic dysfunction-associated steatotic liver disease.