Association between NAFLD and risk of prevalent chronic kidney disease: why there is a difference between east and west?

Abstract

Backgrounds: There is a discrepancy between west and east on the relationship between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). This study aimed to find out the possible reason for this and to clarify the association between NAFLD and CKD by analyzing two population-based datasets from the US and China. Methods: Two health examination datasets from China and the US were used. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m 2 or and/or abnormal albuminuria and/or overt proteinuria. Binary logistic regression was used to examine the association between NAFLD and CKD. Results: A total of 60,965 participants were analyzed, including 11,844 from the US and 51,229 from China. The prevalence of NAFLD was 27.12% in the Chinese population and 36.08% in the US population (p < 0.001). The proportions of CKD and late stage CKD (stages 3-5) were higher in the US population than the Chinese one. NAFLD was independently associated with an increased risk of CKD in Chinese population, whereas in the US population, the NAFLD was not an independent risk factor of CKD. In subgroup analyses which excluded late stages CKD (stages 3-5), the risks of mild renal function decline became consistent: NAFLD was associated with early stages of CKD but not the late stages of CKD in both populations. Conclusion: NAFLD increased the risk of early stages of CKD in both Chinese and the US population. The conflicting results reported by previous studies might result from the different proportion of late stages of CKD.

The Negative Association Between Non-alcoholic Fatty Liver Disease Severity and Gouty Nephropathy in a Non-diabetic Gouty Population: A Cross-Sectional Study

“…Up till now, numbers of studies have explored the relationship between NAFLD and CKD risk in different populations. While numbers of previous studies indicated that the presence of NAFLD was a potential contributory risk factor for the development and progression of CKD, recent studies suggested no adverse association between NAFLD hepatic steatosis and renal function both in general populations and diabetic individuals [19][20][21][22]. Some experts argued that NAFLD itself is not an independent risk factor for CKD, while the comorbidities of NAFLD such as obesity, hypertension, hyperglycemia and hyperuricemia are independently associated with renal dysfunction [23].…”

“…Some experts argued that NAFLD itself is not an independent risk factor for CKD, while the comorbidities of NAFLD such as obesity, hypertension, hyperglycemia and hyperuricemia are independently associated with renal dysfunction [23]. Some also argue that NAFLD was associated with early stages of CKD, but not the late stages of CKD [22]. However, most of previous studies had a much higher prevalence of diabetes in their study samples [24,25], raising the possibility of selection bias given the strong association between diabetes and CKD.…”

“…An interesting observation was that although the independent association of serum UA with metabolic syndrome was recognized [58], this association no longer existed in participants with advanced CKD after adjustment for other metabolic risk factors and renal eGFR [59]. It was also showed that when there are more late stages of CKD, the relationship of NALFD and CKD attenuates during multivariate analysis [22]. In this study, we further con rmed that in subjects with gouty nephropathy, hyperuricemia is no longer associated with the high prevalence of obesity, insulin resistance, hyperlipidemia or NAFLD severity, compared with those without gouty nephropathy.…”

“…The relationship between nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) has attracted much attention, since they share similar risk factors and pathogenic mechanisms, such as insulin resistance (IR), diabetes mellitus (DM), hyperlipidemia and obesity [12][13][14][15][16][17][18]. While numbers of previous studies indicated the presence and severity of NAFLD was a potential contributory risk factor for the development and progression of CKD, recent studies suggested no adverse association between NAFLD hepatic steatosis and renal function both in general populations and diabetic individuals [19][20][21][22]. Some researchers argued that NAFLD itself is not an independent risk factor for CKD, while it is the comorbidities of NAFLD such as obesity, hypertension, and hyperuricemia that are independently associated with CKD [23].…”

“…Some researchers argued that NAFLD itself is not an independent risk factor for CKD, while it is the comorbidities of NAFLD such as obesity, hypertension, and hyperuricemia that are independently associated with CKD [23]. Some also argue that NAFLD was associated with early stages of CKD, but not the late stages of CKD [22]. In addition, although it is reasonable to assume that NAFLD may promote renal damage, it is still uncertain if NAFLD is associated with a speci c type of kidney disease [16].…”