Fatty liver index is independently associated with deterioration of renal function during a 10-year period in healthy subjects

Abstract

A potential link between chronic kidney disease (CKD) and non-alcoholic fatty liver disease (NAFLD) has been suggested. We investigated the relationship between fatty liver index (FLI), a noninvasive and simple predictor of NAFLD, and the development of CKD defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or positive for urinary protein during a 10-year follow-up period in subjects who received annual health examinations (n = 28,890). After exclusion of CKD at baseline, a total of 14,163 subjects (male/female: 9077/5086) were recruited. During the 10-year period, 1458 males (16.1%) and 737 females (14.5%) had new onset of CKD. Multivariable Cox proportional hazard models with a restricted cubic spline showed that hazard ratios (HRs) of CKD development increased with a higher FLI at baseline in both males and females after adjustment of confounders. When divided by tertiles of FLI level at baseline (T1 ~ T3), the adjusted risk of CKD development in the T3 group (HR [95% confidence interval], male/female: 1.33 [1.16–1.54]/1.33 [1.08–1.63]) was significantly higher than that in both sexes in the T1 group as the reference. The addition of FLI into traditional risk factors significantly improved the discriminatory capability for predicting CKD. In conclusion, a high level of FLI predicts the development of CKD in both sexes in a general population.

Urine Uric Acid Excretion Levels are Positively Associated with Obesity and Abdominal Obesity in Type 2 Diabetes Patients without Chronic Kidney Disease

“…Evidence illustrates that the GFR deterioration was associated with progressive impairment in uric acid excretion. 39 , 40 To eliminate the influence of GFR on UUAE, we further analyzed the association between UUAE and obesity and abdominal obesity in the CKD group and non-CKD group. Finally, we found that UUAE was significantly related to obesity and abdominal obesity only in the non-CKD population.…”

The Fatty liver Index (FLI) 15 years later: a reappraisal

“…This dose-response metaanalysis supports a direct association between FLI and HR of incident T2D address this topic, and both seem to confirm the notion that FLI predicts CKD. Sun et al [65] conducted a population-based study on 9436 adult Chinese subjects. The data show that, in logistic regression analysis, compared to those within the lowest FLI quartile, the adjusted ORs of those in the highest FLI quartile were 2.30 (95%CI: 1.36-3.90) for increased urinary albumin excretion and 1.93 (95%CI: 1.18-3.15) for CKD.…”

Nonalcoholic Fatty Liver Disease and the Kidney: A Review

“…In the first, noninvasive fibrosis scoring systems significantly predicted CKD [35], while in the study by Am et al, a higher score of portal inflammation was associated to a 7.7-fold increased risk of renal outcomes [37]. Finally, Takahashi et al suggested the addition of FLI, a noninvasive marker of steatosis, into traditional risk factors for CKD because they found a discriminatory capability of high level of FLI for prediction of CKD in both sexes in a general population [39].…”

“…NAFLD was diagnosed by abdominal ultrasound in five studies [30][31][32][33][34], only three studies used the gold-standard liver biopsy [35][36][37], two studies used the fatty liver index (FLI) [38,39], one study used the fibrosis-4 (FIB-4) score [40] and one study enrolled NAFLD patients by the 10th revision of the International Classification of Diseases (ICD-10) [41]. The diagnosis of CKD was performed according to The Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline as the reduction of GFR < 60 mL/min/1.73 m 2 estimated by different formulae in almost all the studies (KDIGO 2012), except for one study that used the International Classification of Diseases, 10th revision (ICD-10) [41].…”

“…However, obesity, hypertension and hyperuricemia were demonstrated to be independent predictors of CKD in patients with NAFLD [32]. Furthermore, seven studies also found an association between CKD and the severity of NAFLD either assessed by noninvasive scores or by liver biopsy [30,31,[33][34][35]37,39]. After NAFLD diagnosis, the severity of liver fibrosis was assessed by NFS in the majority of the studies.…”