Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes and Chronic Kidney Disease

Abstract

<b><i>Background:</i></b> Nonalcoholic fatty liver disease (NAFLD) is suggested as a risk factor for chronic kidney disease (CKD). The incidence of NAFLD is rising globally in parallel to the increasing incidences of obesity and type 2 diabetes. Diabetes remains the leading cause of CKD, but the co-existence of NAFLD, CKD, and type 2 diabetes is not well elucidated. Here, we evaluated the prevalence of NAFLD in patients with type 2 diabetes with and without CKD. <b><i>Methods:</i></b> This was a cross-sectional study including 50 patients with type 2 diabetes and CKD stages 3–5 (no dialysis), and 50 patients with type 2 diabetes without CKD. Liver fat content was estimated by proton magnetic resonance spectroscopy and magnetic resonance imaging proton density fat fraction. NAFLD was defined as liver fat fraction ≥5.6% according to guidelines. <b><i>Results:</i></b> Mean age was 72 ± 4.9 years in patients with CKD and 65.9 ± 7.8 years in patients without CKD (<i>p</i> < 0.0001). Three out of four participants were men. BMI was 28.6 ± 3.5 kg/m<sup>2</sup> and 27 ± 4.0 kg/m<sup>2</sup> in patients with and without CKD, respectively (<i>p</i> = 0.0087). NAFLD was identified in 22 (44%) patients with CKD and 19 (38%) patients without CKD (<i>p</i> = 0.6845). Median (IQR) liver fat fraction was 4.7% (3.0–8.5) and 4.1% (2.9–7.7) in patients with and without CKD, respectively (difference in geometric means 5.3%, 95% CI −23; 45, <i>p</i> = 0.7463). <b><i>Conclusion:</i></b> These findings do not support any association between NAFLD and CKD (stages 3–5) in patients with type 2 diabetes.

Hepatic Fibrosis Evaluated in Patients with Type 2 Diabetes with and without Chronic Kidney Disease

“…Details on study participants, materials, and methods have previously been described [20]. In brief, this was a cross-sectional study carried out at the Department of Nephrology at Copenhagen University Hospital – Rigshospitalet, and at the Danish Research Centre of Magnetic Resonance (DRCMR), Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark, between June 2019 and June 2021.…”

“…A total of 100 patients were included: 50 patients with type 2 diabetes and CKD stages 3–5 (no dialysis) and 50 patients with type 2 diabetes and normal kidney function without clinical signs of diabetic nephropathy. NAFLD was assessed by 1 H-MRS and MRI-PDFF, as described in detail elsewhere [20].…”

“…Recently, two studies from our group showed similar prevalence of hepatic steatosis in patients with CKD as in those without CKD [19, 20]. Using computed tomography to diagnose NAFLD, similar prevalence of moderate-to-severe hepatic steatosis was found in 291 patients with CKD stages 1–5 as in 866 age- and sex-matched individuals from the Danish background population [19].…”

“…Using computed tomography to diagnose NAFLD, similar prevalence of moderate-to-severe hepatic steatosis was found in 291 patients with CKD stages 1–5 as in 866 age- and sex-matched individuals from the Danish background population [19]. Likewise, using proton magnetic resonance (MR) spectroscopy ( 1 H-MRS) and MR imaging (MRI) proton density fat fraction (MRI-PDFF) as diagnostic tools for NAFLD, we found a similar prevalence of hepatic steatosis in patients with type 2 diabetes with and without CKD ( N = 100) [20].…”

“…Here, we investigated the association between liver fibrosis and kidney function in those patients participating in our latter study ( N = 100), in which a total of 41% were diagnosed with NAFLD [20]. Liver fibrosis was assessed by transient elastography (FibroScan ® ), fibrosis-4 (FIB-4) score, and NAFLD fibrosis score (NFS), respectively.…”