Abstract
Non-alcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). The aim of this retrospective study was to determine the risk factors for progression of CKD in patients with biopsy-proven NAFLD including patatin-like phospholipase domain containing 3 (PNPLA3) polymorphism. A total of 344 patients with biopsy-proven NAFLD were enrolled consecutively in this study. Multivariate analysis identified males (odds ratio (OR) 5.46), age (per 1 year, OR 1.07), and FIB-4 index (≥1.30, OR 3.85) as factors associated with CKD. Of the 154 patients with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min, 30 had a deterioration in CKD stage and 15 developed CKD after 3 years. Multivariate analysis identified diabetes mellitus (OR 2.44) as a risk factor for deterioration in CKD stage, while diabetes mellitus (OR 21.54) and baseline eGFR (per 1 mL/min OR 0.88) were risk factors for development of CKD. PNPLA3 did not affect the change in eGFR. In NAFLD patients, a high FIB-4 index was associated with CKD to increases in the index linked to reductions in eGFR. In order to prevent development of CKD, an appropriate therapy focusing on renal function is needed for NAFLD patients, especially those with diabetes.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Japan and in all countries in the world and has a prevalence of 25–30% in the general adult population [1]
NAFLD covers a wide spectrum of diseases from non-alcoholic fatty liver (NAFL), which is usually benign, to non-alcoholic steatohepatitis (NASH), which can sometimes lead to liver cirrhosis or hepatocellular carcinoma (HCC) without significant alcohol consumption [2,3]
Arase et al reported that the annual incidence of chronic kidney disease (CKD) in Japanese patients with NAFLD was 1.2% and showed the risk of developing CKD was increased by five factors: low estimated glomerular filtration rate, older age, type 2 diabetes mellitus (T2DM), hypertension, and elevated gamma-glutamyltransferase (GGT) [10]
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Japan and in all countries in the world and has a prevalence of 25–30% in the general adult population [1]. NAFLD affects extra-hepatic disease such as type 2 diabetes mellitus (T2DM), cardiovascular disease, and chronic kidney disease (CKD) [4,5,6,7,8]. Arase et al reported that the annual incidence of CKD in Japanese patients with NAFLD was 1.2% and showed the risk of developing CKD was increased by five factors: low estimated glomerular filtration rate (eGFR), older age, T2DM, hypertension, and elevated gamma-glutamyltransferase (GGT) [10]. The objectives of this study were to clarify the prevalence of CKD and the risk factors for CKD in patients with biopsy-proven NAFLD, and to measure changes in liver function to determine the risk factors for deterioration and development of incident CKD including PNPLA3 polymorphism in a follow-up cohort
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