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Abstract Details
Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: an updated meta-analysis
Gut. 2022 Jan;71(1):156-162. doi: 10.1136/gutjnl-2020-323082.Epub 2020 Dec 10.
Alessandro Mantovani1, Graziana Petracca1, Giorgia Beatrice1, Alessandro Csermely1, Amedeo Lonardo2, Jörn M Schattenberg3, Herbert Tilg4, Christopher D Byrne5, Giovanni Targher6
Author information
Endocrinology and Metabolism, University of Verona Department of Medicine, Verona, Veneto, Italy.
Internal Medicine, University of Modena and Reggio Emilia Faculty of Medicine and Surgery, Modena, Emilia-Romagna, Italy.
Department of Internal Medicine I, University Medical Center Mainz Department of Internal Medicine 1, Mainz, Rheinland-Pfalz, Germany.
Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, University of Innsbruck, Innsbruck, Tirol, Austria.
University of Southampton Faculty of Medicine, Southampton, Southampton, UK.
Endocrinology and Metabolism, University of Verona Department of Medicine, Verona, Veneto, Italy giovanni.targher@univr.it.
Abstract
Objective: Studies reported a significant association between non-alcoholic fatty liver disease (NAFLD) and increased risk of chronic kidney disease (CKD). However, whether this risk changes with increasing severity of NAFLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and risk of incident CKD.
Design: We systematically searched PubMed, Web of Science and Scopus from January 2000 to August 2020 using predefined keywords to identify observational studies with a follow-up duration of ≥1 year, in which NAFLD was diagnosed by blood biomarkers/scores, International Classification of Diseases codes, imaging techniques or biopsy. Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling.
Results: 13 studies with 1 222 032 individuals (28.1% with NAFLD) and 33 840 cases of incident CKD stage ≥3 (defined as estimated glomerular filtration rate <60 mL/min/1.73 m2, with or without accompanying overt proteinuria) over a median follow-up of 9.7 years were included. NAFLD was associated with a moderately increased risk of incident CKD (n=10 studies; random-effects HR 1.43, 95% CI 1.33 to 1.54; I 2 =60.7%). All risks were independent of age, sex, obesity, hypertension, diabetes and other conventional CKD risk factors. Sensitivity analyses did not alter these findings. Funnel plot did not reveal any significant publication bias.
Conclusion: This large and updated meta-analysis indicates that NAFLD is significantly associated with a~1.45-fold increased long-term risk of incident CKD stage ≥3. Further studies are needed to examine the association between the severity of NAFLD and risk of incident CKD.