FC003: Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Hyperfiltration In Subjects with Prediabetes and Abdominal Obesity Without Evidence of Chronic Kidney Disease

Abstract

Abstract BACKGROUND AND AIMS The newly defined metabolic dysfunction-associated fatty liver disease (MAFLD) [1] is a multifactorial state that could influence multiple extra-hepatic diseases. Glomerular hyperfiltration (GHF) is an important early determinant of diabetic kidney disease onset and progression in a subgroup of patients, and recently it was reported that prediabetes stage is an independent risk for incident GHF [2]. Currently, no data are available on the association between MAFLD and GHF. The aim of the study was to determine the prevalence of MAFLD and whether and to which extent it is associated with GHF in prediabetic subjects with abdominal obesity and without evidence of chronic kidney disease (CKD). METHOD Data from a total of 6697 civil servants, aged 18–65 years, with prediabetes (fasting plasma glucose ≥100 ≤ 125 mg/dL, American Diabetes Association criteria), abdominal obesity (waist circumference ≥94 cm for men and ≥80 cm for women, International Diabetes Federation criteria) and an estimated glomerular filtration rate (eGFR) ≥60 mL/min, belonging to a large Spanish database of routine occupational health visits (January 2008–December 2010), were included in the analyses. The presence of MAFLD was defined according to the criteria of an international expert consensus statement [1]. Liver steatosis, the first component of MAFLD, was determined by the validated fatty liver index (FLI) with a cut-off value of ≥603. An eGFR was calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [4], deindexed for body surface area (BSA) to avoid underestimation in patients with obesity [5]. Hyperfiltration was defined as an eGFR above the age- and gender-specific 95th percentile. The association between MAFLD and GHF was evaluated by multivariable logistic regression. RESULTS Overall, the prevalence of subjects with MAFLD was 62.9% (n = 4213). Hyperfiltering subjects (n = 330, 4.9%), as compared with non-hyperfiltering subjects, had a higher prevalence of MAFLD (86.4% versus 61.7%, P < .001), higher BMI, waist circumference for both genders, systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP), higher prevalence of arterial hypertension, lower total cholesterol and serum creatinine (P < .05 for all comparisons) (Table 1). In multivariable logistic regression, the presence of MAFLD was independently associated with GHF after adjusting for age, gender, obesity, MAP and smoking status (adjusted OR 3.36, 95% CI 2.33–4.84; P < .001) (Table 2). Receiving operator characteristic curve analysis confirmed the predictive power of MAFLD (area under the curve of 0.623, 95% CI 0.60–0.65; P < .001). CONCLUSION Prediabetic subjects with abdominal obesity are characterized by an increased prevalence of MAFLD that emerges as a possible early risk marker of GHF. This could help general practitioners to timely identify patients at high risk and to start weight loss with appropriate calorie restriction and lifestyle modification strategies. Longitudinal studies are needed to investigate whether MAFLD in prediabetes is associated with a later decline in eGFR.