Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients

Abstract

Aims/hypothesis Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease in type 2 diabetes. Currently, there is a lack of information on associations between NAFLD and microvascular complications of diabetes. We assessed the associations between NAFLD and both chronic kidney disease (CKD) and retinopathy in a large cohort of type 2 diabetic individuals using a cross-sectional design.Methods Prevalence rates of retinopathy (by ophthalmoscopy) and CKD (defined as overt proteinuria and/or estimated GFR ≤60 ml min) were assessed in 2,103 type 2 diabetic individuals who were free of diagnosed cardiovascular disease and viral hepatitis. NAFLD was ascertained by patient history, blood sampling and liver ultrasound. Results NAFLD patients had higher (p<0.001) age-and sex-adjusted prevalence rates of both non-proliferative (39 vs 34%) and proliferative/laser-treated retinopathy (11 vs 5%), and CKD (15 vs 9%) than counterparts without NAFLD. In logistic regression analysis, NAFLD was associated with increased rates of CKD (odds ratio 1.87; 95% CI 1.3-4.1, p=0.020) and proliferative/laser-treated retinopathy (odds ratio 1.75; 1.1-3.7, p=0.031) independently of age, sex, BMI, waist circumference, hypertension, diabetes duration, HbA 1c , lipids, smoking status and medications use. Conclusions/interpretation Our findings suggest that NAFLD is associated with an increased prevalence of CKD and proliferative/laser-treated retinopathy in type 2 diabetic individuals independently of numerous baseline confounding factors. Further studies are required to confirm the reproducibility of these results and to evaluate whether NAFLD contributes to the development or progression of CKD and retinopathy.

Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups

“…8,120,121 Emerging evidence also suggests that NAFLD is associated with increased risk of microvascular diabetic complications (i.e., chronic kidney disease and advanced diabetic retinopathy) in people with T2DM. [122][123][124] Overall, we believe that the strong link between T2DM and NAFLD supports more careful monitoring and evaluation of NAFLD among patients with T2DM.…”

Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease

“…In the last 5 years, a number of cross-sectional community-based and hospital-based studies have consistently demonstrated that NAFLD, as diagnosed either by imaging [16][17][18][19][20][21][22][23][24] or by histology [25][26][27][28][29] , is associated with an increased prevalence of CKD (defined as presence of decreased estimated glomerular filtration rate [eGFR] or abnormal albuminuria or overt proteinuria) in patients with NAFLD. In these studies, the prevalence of CKD in patients with NAFLD ranged from approximately 20% to 55% compared to 5%-30% in those without NAFLD [16][17][18][19][20][21][22][23][24][25][26][27][28][29] .…”

“…In these studies, the prevalence of CKD in patients with NAFLD ranged from approximately 20% to 55% compared to 5%-30% in those without NAFLD [16][17][18][19][20][21][22][23][24][25][26][27][28][29] . Notably, in most of these studies the association between NAFLD and CKD was independent of common cardio-renal risk factors across a wide range of patient populations.…”

Mediterranean diet in type 2 diabetes

“…In addition to emerging evidence that Mediterranean diets have a positive effect on cardiovascular epidemiology [8], a classical Mediterranean diet may be the ideal model for the prevention of diabetes [6] and its complications, including some consequences of non-alcoholic fatty liver disease, in type 2 diabetic individuals, such as chronic kidney disease and retinopathy [9].…”