Author information
1
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
2
Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States.
Abstract
BACKGROUND & AIMS:
Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share similar pathophysiologic features. Our aim was to assess the association between different stages of CKD and mortality in patients with NAFLD.
METHODS:
NHANES-III-linked mortality files were utilized. NAFLD was diagnosed by hepatic ultrasound and CKD was defined according to the Kidney Disease Improving Global outcomes guideline. Multivariable Cox proportional hazard model was used to assess the effect of CKD on overall and cardiovascular mortality.
RESULTS:
Total cohort included 11,695 adult participants; mean age 43.3 years, 48.4% male, 76.4% white, 18.6% had NAFLD and 9.3% had CKD. 5.6% had diabetes, 21.3% had hypertension, 4.3% had cardiovascular disease. Compared to subjects without CKD or NAFLD, NAFLD patients with CKD were more likely to be older, had less income, and higher prevalence of comorbidities (all p<.001). Prevalence of CKD among NAFLD cohort was 11.31%. Compared to non-NAFLD group, patients with NAFLD had higher rates of stage 1, 2 and 3a CKD, but similar rates for stage 3b, 4 and 5. Mortality rate was 18.5% in 17 years. Among NAFLD cohort, presence of CKD stages 2-3a (HR=2.31, 95% CI: 1.70 - 3.15) and stages 3b-5 (HR=4.83, 95% CI: 2.40 - 9.71) were independently associated with increased overall mortality.
CONCLUSIONS:
Among patients with NAFLD, moderate to advanced stages of CKD are associated with overall mortality. Identification of CKD in NAFLD has important prognostic implications.