Role of non-alcoholic fatty liver disease in the evolution of renal function in patients with diabetes mellitus

Abstract

Background Increasing prevalence in type 2 diabetes mellitus (T2DM) have influenced in an increasing prevalence of chronic kidney disease (CKD). Little is known about the influence of non-alcoholic fatty liver disease (NAFLD) on progression of CKD. The aim of this study was to analyse the role of NAFLD and its severity in the progression of renal function in patients with T2DM. Methods Retrospective and observational study, including patients with T2DM and estimated glomerular filtration rate (eGFR) >30 ml/min/1,73m2. NAFLD was defined with presence of compatible ultrasonography and/or presence of fibrosis using NAFLD score. Patients were classified in three groups according to the NAFLD score; group 1 <-1.85, group 2 -1.85 to 0.18, and group 3 > 0.18. Results A total of 102 patients were included (67.6% males, median age 59 [53-64] years), with median time of T2DM evolution was 70 [39-131] months. Group 3 had lower eGFR (84.8 ± 40.4 vs 71.4 ± 30.6 ml/min/1.73m2; p = 0.03) and higher proteinuria at baseline (0.56 ± 0.77 vs 1.59 ± 2.70 g/24h; p = 0.05). After a follow-up time of 75.8 ± 23.9 months, group 3 had a significant decrease in eGFR (66.6 ± 33.3 vs 36.8 ± 23.1 ml/min/1.73m2; p = <0.01), and higher risk of CKD progression (OR 7.50; CI 95% 2.76-20.35; p = <0.001) defined as decrease in > 50% eGFR. Conclusions The presence of NAFLD with high-risk fibrosis confers higher risk of CKD progression in patients with T2DM. Therefore, NAFLD should be a risk factor evaluated in these patients to optimise treatment.

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

“…Importantly, only hepatic steatosis is evaluated in the mentioned studies, and thus, preclusion of any association between CKD and the more severe stages of the NAFLD spectrum cannot be made by these studies. In fact, an association between fibrosis and increased risk of CKD has been suggested by several studies, the most recent study being one by Aubert et al [52]. Here, CKD progression was found to be greater in patients with type 2 diabetes with an eGFR >30 mL/min/1.73 m 2 having a high risk of hepatic fibrosis compared with those with low risk for fibrosis.…”

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

“…Numerous studies have reported a significant association between NAFLD and CKD ( 6 , 11 – 14 ). Recently, a significant association between MAFLD and CKD was established in cross-sectional and cohort studies ( 16 – 18 ).…”

“…Diabetes is the leading cause of CKD, and CKD is considered to share common metabolic risk factors with NAFLD, such as T2DM ( 6 ). The association between NAFLD and CKD is established in several epidemiological studies ( 11 – 15 ), two of which are based on patients with diabetes ( 11 , 12 ). The risk of CKD progression increased with the severity of NAFLD in patients with T2DM ( 11 ).…”

“…The association between NAFLD and CKD is established in several epidemiological studies ( 11 – 15 ), two of which are based on patients with diabetes ( 11 , 12 ). The risk of CKD progression increased with the severity of NAFLD in patients with T2DM ( 11 ). Putative mechanisms linking NAFLD with CKD include T2DM and metabolic syndrome, dysbiosis and perturbed intestinal function, and aging ( 6 ).…”

Anything New in the Treatment of Obesity in Obese Patients with CKD?

“…Lanzon et al [46] recently showed that patients with severe obesity and CKD displayed significant differences in lipid signature, changes in specific amino acids and downregulation of levels of triglycerides and diglycerides when compared to obese subjects without CKD. These changes in lipid signature also play a role in the development of nonalcoholic fatty liver, a highly prevalent condition in diabetic and obese patients which has recently been proven as a key factor in the progression of diabetic kidney disease [47].…”