Nonalcoholic Fatty Liver Disease Related to Increased Incidence of CKD

Nonalcoholic fatty liver disease (NAFLD) was significantly associated with an increased incidence of chronic kidney disease (CKD), a meta-analysis published in Advances in Clinical and Experimental Medicine shows. In addition, NAFLD incidence was shown to be higher among patients living with diabetes.

CKD affects approximately 25% of people 65 years and older in the Western world, and 30% of adults have NAFLD, which is the hepatic manifestation of metabolic syndrome. NAFLD has also been found to raise the risk of cirrhosis, which is linked to nonalcoholic steatohepatitis. Previous research and experiments have found that NAFLD and CKD interact and can share pathogenic mechanisms. The aim of this review was to assess the relationship between NAFLD and CKD incidence in patients with and without diabetes compared with controls.

Studies included in the meta-analysis were randomized controlled trials, prospective studies, and retrospective studies. Studies that compared NAFLD and controls and estimated the role of NAFLD and diabetes in the development of CKD were considered, as were studies that examined the prevalence of CKD in people with NAFLD who did or did not have diabetes.

Nineteen studies were collected through a comprehensive literature search of MEDLINE/PubMed, the Cochrane Library, OVID, Embase, and Google Scholar for published dates between January 1, 2005, and April 30, 2022. Total participants, interventional groups, and control groups; the conclusion; and outcomes related to the meta-analysis criteria were all extracted from the included studies. All included studies were published between 2008 and 2021, and they accounted for 1,111,046 participants, 310,804 of whom had NAFLD.

There were 18 clinical trials that compared the incidence of CKD in NAFLD subjects with the control group. The incidence of CKD was found to be significant in NAFLD subjects compared with controls (o ratio [OR], 1.95; 95% CI, 1.65-2.31).

There were 5 studies that compared the incidence of CKD between patients with diabetes who did or did not have NAFLD and 6 studies evaluated the effect of diabetes on the incidence of CKD in patients with NAFLD vs patients with NAFLD and without diabetes as the control. There was an increased incidence of CKD in patients who did not have diabetes comorbid with with NAFLD (OR, 1.79; 95% CI, 1.35-2.38) compared with non-NAFLD when evaluating the effect of diabetes as a comorbidity.

Diabetes was also found to act as a risk factor for CKD, as incidence of CKD increased for patients living with diabetes and NAFLD vs patients with just NAFLD (OR, 1.82; 95% CI, 1.15-2.88). Incidence of CKD was higher in the NAFLD cohort compared with patients who did nto have NAFLD or diabetes (OR, 2.52; 95% CI, 1.91-3.32).

There were some limitations to this study. There were publications left out of the meta-analysis for not meeting the inclusion criteria, which could have introduced a bias in the results. There was also uncertainty in how to incorporate gender and race into the analysis. The average weight of the participants also varied from study to study.

The researchers concluded that this meta-analysis determined that the incidence of CKD was significant in patients with NAFLD compared with the control group. Patients who had diabetes but not NAFLD also had an increased incidence of CKD compared with the patients who had NAFLD but not diabetes.

Reference

Chen Y, Bai W, Mao D, et al. The relationship between non-alcoholic fatty liver disease and incidence of chronic kidney disease for diabetic and non-diabetic subjects: a meta-analysis. Adv Clin Exp Med. Published online November 22, 2022. doi:10.17219/acem/155017