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Metabolic dysfunction-associated fatty liver disease and risk of incident chronic kidney disease: A nationwide cohort study - 27/07/22

Doi : 10.1016/j.diabet.2022.101344 
Chan-Young Jung a, Hee Byung Koh a, Keun Hyung Park a, Young Su Joo a, Hyung Woo Kim a, Sang Hoon Ahn a, b, Jung Tak Park a, c, , Seung Up Kim a, b,
a Department of Internal Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea 
b Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea 
c Institute of Kidney Disease Research, Yonsei University, College of Medicine, Seoul, Republic of Korea 

Corresponding authors.

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Abstract

Aims

The recently proposed metabolic dysfunction-associated fatty liver disease (MAFLD) has been suggested to better reflect the metabolic components of fatty liver disease (FLD), compared to nonalcoholic fatty liver disease (NAFLD). This study investigated whether MAFLD identifies a higher proportion of individuals at risk of developing chronic kidney disease (CKD).

Methods

268,946 participants aged 40–64 years, who underwent National Health Insurance Service health examinations between 2009 and 2015 were included. Participants were categorized by presence of FLD, according to MAFLD or NAFLD. In participants with FLD, participants were categorized into three groups: non-metabolic risk (non-MR) NAFLD, MAFLD but not NAFLD, and overlapping FLD. Incident CKD was defined as the occurrence of eGFR < 60 mL/min/1.73m2 or proteinuria (≥ trace) on two consecutive health examinations.

Results

73,726 (27.4%) and 88,762 (33.0%) participants had NAFLD and MAFLD, respectively. During a median follow-up of 5.1 years, CKD occurred in 8,335 (6.2/1,000 person-years) participants. Compared to non-NAFLD participants, the adjusted hazard ratio (aHR) for incident CKD was 1.33 (95% CI, 1.27–1.39; P < 0.001) for participants with NAFLD. Compared to non-MAFLD participants, the aHR for participants with MAFLD was 1.39 (95% CI, 1.33–1.46; P < 0.001). When the analysis was confined to participants with FLD, compared to non-MR NAFLD participants, the aHRs for participants with MAFLD but not NAFLD, and those with overlapping FLD were 1.18 (95% CI, 1.01–1.39; P = 0.040) and 1.36 (95% CI, 1.19–1.54; P < 0.001), respectively.

Conclusion

MAFLD identified a higher proportion of individuals at risk of developing CKD than NAFLD.

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Keywords : Chronic kidney disease, Metabolic dysfunction-associated fatty liver disease, Nonalcoholic fatty liver disease, Outcomes, Risk factors

Abbreviations : NAFLD, CKD, CVD, ESKD, MAFLD, FLD, NHIS, eGFR, FLI, BMI, MR, NSAIDs, HR, CI, LDL, AST, ALT, HSI, NHANES


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Vol 48 - N° 4

Artículo 101344- juillet 2022 Regresar al número
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