Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Chronic Kidney Disease in Patients With Type 1 Diabetes

Abstract

OBJECTIVEThere is no information about the role of nonalcoholic fatty liver disease (NAFLD) in predicting the development of chronic kidney disease (CKD) in type 1 diabetes. RESEARCH DESIGN AND METHODSWe studied 261 type 1 diabetic adults with preserved kidney function and with no macroalbuminuria at baseline, who were followed for a mean period of 5.2 years for the occurrence of incident CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m 2 and/or macroalbuminuria). NAFLD was diagnosed by ultrasonography. RESULTSAt baseline, patients had a mean eGFR of 92 6 23 mL/min/1.73 m 2 ; 234 (89.7%) of them had normoalbuminuria and 27 (10.3%) microalbuminuria. NAFLD was present in 131 (50.2%) patients. During follow-up, 61 subjects developed incident CKD. NAFLD was associated with an increased risk of incident CKD (hazard ratio [HR] 2.85 [95% CI 1.59-5.10]; P < 0.001). Adjustments for age, sex, duration of diabetes, hypertension, A1C, and baseline eGFR did not appreciably attenuate this association (adjusted HR 2.03 [1.10-3.77], P < 0.01). Results remained unchanged after excluding those who had microalbuminuria at baseline (adjusted HR 1.85 [1.03-3.27]; P < 0.05). Addition of NAFLD to traditional risk factors for CKD significantly improved the discriminatory capability of the regression models for predicting CKD (e. CONCLUSIONSThis is the first study to demonstrate that NAFLD is strongly associated with an increased incidence of CKD. Measurement of NAFLD improves risk prediction for CKD, independently of traditional cardio-renal risk factors, in patients with type 1 diabetes.Nonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions worldwide (1). Up to 30% of adults in the U.S. and Europe have NAFLD, and the prevalence of this disease is much higher in people with diabetes (1,2). Indeed, the prevalence of NAFLD on ultrasonography ranges from ;50 to 70% in patients with type 2 diabetes (3-5) and

Intrahepatic triglyceride content is independently associated with chronic kidney disease in obese adults: A cross-sectional study

“…Targher et al showed that NAFLD (or NASH) is independently associated with an increased presence of CKD, after adjusting for traditional cardio-renal risk factors in type 2 diabetic patients [OR (95% CI): 1.87 (1.3-4.1), P = 0.020] and in overweight subjects with biopsy-proven NASH [OR (95% CI): 6.14 (1.6-12.8), P < 0.001] [13,30]. A recent prospective study from the same group demonstrated that NAFLD was independently associated with an increased risk of CKD in type 1 diabetic patients [HR (95% CI): 1.85 (1.03-3.27), P < 0.05] and NAFLD together with traditional cardio-renal risk factors significantly increased the capability to predict incident CKD in type 1 diabetic patients [15]. However, the shared risk factors by NAFLD and CKD, including abdominal obesity and insulin resistance etc.…”

“…Growing evidence shows that NAFLD patients possess multiple risk factors for CKD [8][9][10][11][12] and NAFLD is associated with the incidence of CKD [13][14][15][16][17][18]. However, the dose-response association of intrahepatic triglyceride content and CKD was not well investigated.…”

“…It was reported that NAFLD was associated with an increase in the incidence of CKD [13][14][15][16][17][18]. However, the dose-response association between intra-hepatic triglyceride (IHTG) content and the presence of CKD has not been clearly delineated.…”

Increased microalbuminuria prevalence among patients with nonalcoholic fatty liver disease

“…Targher et al studied 261 Type 1 diabetic adults with preserved kidney function and with no macroalbuminuria at baseline and followed them for a mean period of 5.2 years for the occurrence of incident chronic kidney disease and demonstrated that NAFLD is strongly associated with an increased incidence of chronic kidney disease. 17 Jenks et al studied on 933 patients with Type 2 diabetes and in 4 years follow-up they reported that the presence of nonalcoholic fatty liver disease was not associated with decline in renal function. 18 Interestingly, in a study of Ryu et al on 10,337 healthy Korean men who were followed for approximately 3.5 years, mildly elevated serum gamma glutamyl transaminase concentrations, as surrogate markers of NAFLD, are associated with an increased risk for chronic kidney disease.…”

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

“…The results remained unchanged even after excluding those patients who had microalbuminuria at baseline. Notably, addition of NAFLD to traditional risk factors for CKD significantly improved the discriminatory capability of the regression models for predicting incident CKD 33 .…”