Nonalcoholic Fatty Liver Disease and the Risk of Incident Chronic Kidney Disease: A Meta-Analysis

Yi‐Chao Zheng

doi:10.11648/j.ijcems.20180402.12

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease that affects many extrahepatic-organ systems. In this respect, several studies have suggested the possible association between NAFLD and the risk of incident chronic kidney disease (CKD). However, the extent of this association remains unclear. Thus the present meta-analysis was conducted to better characterize this association. In the meta-analysis, a comprehensive search of the databases of MEDLINE, EMBASE, Web of Science and Cochran Library was carried out from inception through September 2017. All large observational studies that investigated the association between NAFLD and the risk of incident CKD were included. The incident CKD was defined as occurrence of estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2 and/or overt proteinuria. The pooled hazard ratio (HR) with 95% confidence intervals (CIs) was calculated using the random-effects model. Data were extracted from 5 large observational studies involving 57,341 adult individuals (41.3% with NAFLD) with 1,886 cases of incident CKD. NAFLD is significantly associated with increased risk of incident CKD (HR 1.40, 95%CI 1.22-1.61). The statistical heterogeneity of included studies was low, with an I2=25.4%. In conclusion, the present meta-analysis confirms the association between NAFLD and the risk of incident CKD.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is one of the most commonly diagnosed liver diseases, affecting up to 33% of population worldwide [1]
The inclusion criteria for eligible studies were as follows: (i) large observational cohort studies with a sample size of at least 250 participants and a follow-up duration of at least one year; (ii) Studies evaluated the association between NAFLD and the risk of incident chronic kidney disease (CKD); (iii) NAFLD was diagnosed by either abdominal imaging study or liver biopsy; (iv) incident CKD was defined as occurrence of estimated glomerular filtration rate < 60ml/min/1.73m2 and/or overt proteinuria
In five large observational cohort studies included in the present meta-analysis, 1,886 new cases of incident CKD developed in 57,341 adult individuals (41.3% with NAFLD) over a medium follow-up duration of 5.2 years [13,14,15,16,17]

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is one of the most commonly diagnosed liver diseases, affecting up to 33% of population worldwide [1]. The harm of NAFLD is not limited to liver causing nonalcoholic hepatitis, cirrhosis and liver cancer, accumulating clinical evidence indicates that the risks of developing cardiovascular and other extrahepatic diseases are increased in patients with NAFLD [3, 4] In this respect, the possible link between NAFLD and chronic kidney disease (CKD) has drawn considerable scientific attention recently [5]. The mechanism underlying this association has not well established, experimental studies postulated that increased insulin resistance, atherogenic dyslipidemia, and the presence of proinflammatory, procoagulant, pro-oxidant, and profibrogenic mediators may be the possible explanations [3,4,5,6,7,8,9] To better understand this association and estimate the risk of CKD in NAFLD patients, a meta-analysis was conducted to address this issue

Methods

Results

Discussion

Conclusion