Fatty liver tied to increased risk for advanced CKD

  • Park H & al.
  • J Intern Med
  • 29.07.2019

  • von Yael Waknine
  • Clinical Essentials
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Takeaway

  • Nonalcoholic fatty liver disease (NAFLD) is a significant and independent risk factor for advanced (stage III-V) chronic kidney disease (CKD).

Why this matters

  • NAFLD is associated with extrahepatic manifestations such as diabetes, cardiovascular disease, and CKD.
  • Moderate-advanced CKD has been linked to early death in NAFLD.
  • Renal function should be regularly evaluated with an eye toward reducing any modifiable CKD risk factors.

Study design

  • Study of 262,619 patients newly diagnosed with NAFLD, propensity-matched 1:3 with 769,878 non-NAFLD patients, using the Truven Health MarketScan Database (2006-2015).
  • Funding: NIH.

Key results

  • Crude incidence of advanced CKD was higher in patients with NAFLD than without (8.2 vs 5.5 per 1000 person-years).
  • In multivariate analysis, NAFLD was tied to a 41% increased risk for CKD (adjusted [a]HR, 1.41; 95% CI, 1.36-1.46).
  • Findings were supported in sensitivity analyses adjusting for:
    • Time-varying covariates after diagnosis (aHR, 1.58; 95% CI, 1.52-1.66).
    • HCV/HBV/alcoholic liver disease (aHR, 1.43; 95% CI, 1.38-1.48).
  • CKD risk (aHRs; 95% CIs) in NAFLD was exacerbated by:
    • Compensated cirrhosis: 1.47 (1.36-1.59).
    • Decompensated cirrhosis: 2.28 (2.12-2.46).
    • Diabetes: 1.20 (1.07-1.35).
    • Obesity: 1.26 (1.06-1.50).
    • Congestive heart failure: 1.22 (1.06-1.40).
    • Male sex: 1.31 (1.24-1.38).
    • Aged ≥60 years: 4.10 (3.78-4.46).

Limitations

  • Retrospective design.
  • Limited to ICD-10 codes.