Association of metabolic dysfunction-associated fatty liver disease, type 2 diabetes mellitus, and metabolic goal achievement with risk of chronic kidney disease

Abstract

BackgroundAlthough type 2 diabetes mellitus (T2DM) plays a significant role in the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD), how T2DM development and glycemic deterioration affect CKD and its renal function indicators, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), remains unknown. We aimed to assess the association between MAFLD, along with T2DM, and risk of CKD, and then evaluate the effect of metabolic goal achievement in MAFLD on the risk of CKD.MethodsIn this cross-sectional study, 5,594 participants were included. Multivariate logistic regression and linear regression were used to examine the association between MAFLD with its T2DM status and metabolic goal achievement and risk of CKD, as well as eGFR and UACR.ResultsThe MAFLD group had a higher prevalence of CKD (16.2 vs. 7.6%, P < 0.001) than the non-MAFLD group. MAFLD was independently associated with an increased risk of CKD (odds ratio [OR]: 1.35, 95% CI: 1.09–1.67) and increased eGFR and UACR. Among the three MAFLD subtypes, only the T2DM subtype exhibited significant associations with increased risk of CKD (OR: 2.85, 95% CI: 2.24–3.63), as well as increased eGFR and UACR. Glycemic deterioration in MAFLD was dose-dependently associated with an increased risk of CKD (P-trend < 0.001). Achieved metabolic goals in MAFLD decreased the risk of CKD, eGFR, and UACR; MAFLD with 2 or 3 achieved metabolic goals was not significantly associated with the risk of CKD (OR: 0.81, 95% CI: 0.59–1.12) and albuminuria.ConclusionMAFLD was independently associated with an increased risk of CKD, as well as increased eGFR and UACR. This association is strongly driven by T2DM status. Glycemic deterioration in MAFLD was dose-dependently associated with an increased risk of CKD. Achieved metabolic goals in MAFLD decreased the risk of CKD by reducing the risk of albuminuria.

MAFLD and glomerular hyperfiltration in subjects with normoglycemia, prediabetes and type 2 diabetes: A cross‐sectional population study

“…15,16 In turn, MAFLD increases the risk and severity of CVD and CKD even more strongly than NAFLD both in individuals with or without diabetes. [17][18][19] Moreover, preliminary data show that MAFLD is also associated with glomerular hyperfiltration in subjects with T2DM 20 or prediabetes and visceral obesity. 21 Together, these two abnormalities might synergistically contribute to the pathogenesis of CKD in these populations.…”

Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: a systematic review and meta-analysis

“…Moreover, MAFLD has been linked to an elevated risk of cardiovascular disease, compounding the existing burden in individuals with diabetes [9]. Recent study has reported that among persons at risk for MAFLD, persons with T2D pose nearly a three-fold risk of chronic kidney disease [6]. Even more disconcerting, studies have demonstrated that among individuals with MAFLD, those with T2D are at a higher risk of liver-related mortality compared with those without T2D [10][11][12].…”

Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: A systematic review and meta-analysis

“…T2D is a major risk factor for MAFLD and a predictor of poor liver-related health outcomes among people living with MAFLD [ 6 , 7 ]. In a previous meta-analysis, researchers found a 55.5% prevalence of MAFLD among individuals with T2D worldwide (compared with the 32.4% in the general population) [ 7 ].…”