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Association between fatty liver index and risk of end-stage renal disease stratified by kidney function in patients with type 2 diabetes: a nationwide population-based study - 25/05/23

Doi : 10.1016/j.diabet.2023.101454 
Goh Eun Chung 1, #, Kyungdo Han 2, #, Kyu-Na Lee 3, Jung Ho Bae 1, Sun Young Yang 1, Su-Yeon Choi 1, Jeong Yoon Yim 1, Nam Ju Heo 1,
1 Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea 
2 Department of Biostatistics, College of Medicine, The Soongsil University, Seoul, Republic of Korea 
3 Department of Biomedicine & Health Science, Catholic University of Korea, Seoul, Republic of Korea 

Correspondence to: Nam Ju Heo, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea. Tel: +82-2-2112-5755, Fax: +82-2-2112-5510Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University HospitalSeoulRepublic of Korea
Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 25 May 2023

Abstract

Objective

The effects of nonalcoholic fatty liver disease on the risk of end-stage renal disease (ESRD) remain unclear. We investigated the association between the fatty liver index (FLI) and risk of ESRD in patients with type 2 diabetes.

Methods

This population‐based observational cohort study enrolled patients with diabetes who underwent health screening between 2009 and 2012 and utilized data from the Korean National Health Insurance Services. The FLI functioned as a surrogate marker for the presence of hepatic steatosis. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate ˂60 ml/min/1.73 m² calculated using the Modification of Diet in Renal Disease equation. We performed Cox proportional hazards regression.

Results

Incident ESRD developed in 40,863 of 1,900,598 patients with type 2 diabetes during a median follow-up of 7.2 years. After adjusting for conventional risk factors, patients with high FLI scores had a higher risk for ESRD: FLI, 30–59 [hazard ratio (HR) = 1.124; 95% confidence interval (CI), 1.083–1.166]; FLI ≥ 60 [HR = 1.278; 95% CI, 1.217–1.343] compared with those with FLI < 30. The association between a high FLI score (≥ 60) and incident ESRD was more prominent in women than in men (male, FLI ≥60: HR, 1.106; 95% CI = 1.041–1.176 and female, FLI ≥ 60: HR, 1.835; 95% CI = 1.689–1.995). The association between a high FLI score (≥ 60) and the risk of ESRD differed according to baseline kidney function. High FLI scores increased the risk of ESRD (HR = 1.268; 95% CI, 1.198–1.342) in patients with CKD at baseline.

Conclusion

High FLI scores are associated with a greater risk of ESRD in patients with type 2 diabetes with CKD at baseline. Close monitoring and appropriate management of hepatic steatosis may aid in preventing the progression of kidney dysfunction in patients with type 2 diabetes and CKD.

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Keywords : Chronic kidney disease, End-stage renal disease, Hepatic steatosis, Type 2 diabetes


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© 2023  Publié par Elsevier Masson SAS.
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