Higher liver stiffness scores are associated with early kidney dysfunction in patients with histologically proven non-cirrhotic NAFLD - 11/09/20

Doi : 10.1016/j.diabet.2019.11.003

D.-Q. Sun ^a,^b,^{^{1
Co-first authors.}}, F.-Z. Ye ^c,^d,^{^{1
Co-first authors.}}, H.T. Kani ^e,^{^{1
Co-first authors.}}, J.-R. Yang ^f, K.I. Zheng ^c, H.-Y. Zhang ^g, G. Targher ^h, C.D. Byrne ⁱ, Y.-P. Chen ^c,^j,^l, W.-J. Yuan ^b, Y. Yilmaz ^e,^k,^{^{2
Guarantor of article.},}^⁎ , M.-H. Zheng ^c,^j,^{^{2
Guarantor of article.},}^⁎
^a Department of Nephrology, Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
^b Department of Nephrology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
^c NAFLD Research Centre, Department of Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
^d School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
^e Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
^f Department of Clinical Laboratory, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
^g School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
^h Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
ⁱ Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK
^j Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
^k Institute of Gastroenterology, Marmara University, Istanbul, Turkey
^l Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China

^⁎Corresponding author at: Department of Gastroenterology, Marmara University School of Medicine, Istanbul 34662, Turkey.Department of Gastroenterology, Marmara University School of MedicineIstanbul 34662Turkey^⁎⁎Corresponding author at: NAFLD Research Center, Department of Hepatology, First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou 325000, China.NAFLD Research Center, Department of Hepatology, First Affiliated Hospital of Wenzhou Medical UniversityNo. 2 Fuxue LaneWenzhou 325000China

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Abstract

Aim

The association between Liver fibrosis (LF), as assessed by either histology or Liver stiffness measurement (LSM), and the presence of Early kidney dysfunction (EKD) was investigated in this study, as was also the diagnostic performance of LSM for identifying the presence of EKD in patients with Non-alcoholic fatty liver disease (NAFLD).

Materials and methods

A total of 214 adults with non-cirrhotic biopsy-proven NAFLD were recruited from two independent medical centres. Their histological stage of LF was quantified using Brunt's criteria. Vibration-controlled Transient elastography (TE), using M-probe (FibroScan®) ultrasound, was performed in 154 patients and defined as significant when LSM was≥8.0kPa. EKD was defined as the presence of microalbuminuria with an estimated glomerular filtration rate≥60mL/min/1.73 m². Logistic regression modelling was used to estimate the likelihood of having EKD with NAFLD (LSM–EKD model).

Results

The prevalence of EKD was higher in patients with vs without LF on histology (22.14% vs 4.82%, respectively; P<0.001) and, similarly, EKD prevalence was higher in patients with LSM≥8.0kPa vs LSM<8.0kPa (23.81% vs 6.59%, respectively; P<0.05). The area under the ROC curve of the LSM–EKD model for identifying EKD was 0.80 (95% CI: 0.72–0.89). LF detected by either method was associated with EKD independently of established renal risk factors and potential confounders.

Conclusion

LF was independently associated with EKD in patients with biopsy-proven NAFLD. Thus, TE-measured LSM, a widely used technique for quantifying LF, can accurately identify those patients with NAFLD who are at risk of having EKD.

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Keywords : Early kidney dysfunction, Liver fibrosis, Liver stiffness measurement, Non-alcoholic fatty liver disease

Abbreviations : ACR, AUROC, BMI, CI, CKD, eGFR, EKD, HOMA-IR, NAFLD, OR, LSM, LF, TE

Plan

Introduction

Materials and methods

Study design

Liver biopsy and transient elastography

Clinical and laboratory data

Authors’ contributions

Disclosure of interest

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Vol 46 - N° 4

P. 288-295 - septembre 2020 Retour au numéro

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Higher liver stiffness scores are associated with early kidney dysfunction in patients with histologically proven non-cirrhotic NAFLD - 11/09/20

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