IDF21-0280 Nonalcoholic Fatty Liver Disease Increases the Risk of End-Stage Renal Disease in Biopsy-Confirmed Diabetic Nephropathy

Abstract

Background: Diabetic nephropathy (DN) continues to be the leading cause of end-stage renal disease (ESRD) worldwide. People with ESRD must undergo dialysis or kidney transplantation to prolong survival, placing a heavy burden on people and the world. Therefore, it is essential to find new risk factors for ESRD in these patients. Nonalcoholic fatty liver disease (NAFLD) is another global health challenges and closely related to type 2 diabetes (T2D). However, whether NAFLD increases the risk of incident ESRD in people with DN is still unknown. Aim: To investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and end-stage renal disease (ESRD) in patients with biopsy-confirmed diabetic nephropathy (DN). Method: A total of 354 patients with biopsy-confirmed DN between January 2008 and July 2019 were retrospectively assessed. Kaplan-Meier curve and Cox proportional hazard models were used to compare the risk of incident ESRD in patients with and without NAFLD, after using propensity score-matching (PSM) to address the imbalances of sex, age, baseline estimated glomerular filtration rate, serum albumin, 24-hour urine protein, hemoglobin and systolic blood pressure. Results: Fifty-two patients with NAFLD have a higher level of HbA1c, triglyceride, total cholesterol, usage of ACEI or ARB and usage of statins or fibrates, compared with 52 propensity-matched patients without NAFLD. During the median follow-up period of 3.3-year, there are 21 ESRD outcome events (20.19%). Kaplan–Meier curve analysis suggests that renal survival significantly deteriorated in patients with NAFLD versus those without NAFLD in PSM cohort (p=0.045). Additionally, the HRs (95% confidence interval, CI) of NAFLD are 2.77 (p=0.043), 4.73 (p=0.015) and 3.60 (p=0.041), after adjustment for three models, respectively. Discussion: NAFLD increases the risk of incident ESRD in patients with biopsy-proven DN. Treatment targeting NAFLD might improve the prognosis of DN.