The association between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: A systematic review and meta-analysis

Agustanti, Nenny; Soetedjo, Nanny Natalia Mulyani; Damara, Fachreza Aryo; Iryaningrum, Maria Riastuti; Permana, Hikmat; Bestari, Muhammad Begawan; Supriyadi, Rudi

doi:10.1016/j.dsx.2023.102780

Cited by 12 publications

(6 citation statements)

References 41 publications

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“…Accumulating evidence shows an intimate inter‐relationship between MAFLD and CKD 38,39 . A recent international consensus statement also highlighted that underlying metabolic dysfunction is probably the most important mechanistic link between MAFLD and CKD 11 .…”

Section: Discussionmentioning

confidence: 99%

Serum PRO‐C3 is useful for risk prediction and fibrosis assessment in MAFLD with chronic kidney disease in an Asian cohort

Tang,

Sun,

Song

et al. 2024

Liver International

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BackgroundMetabolic dysfunction‐associated fatty liver disease (MAFLD) is an emerging risk factor for chronic kidney disease (CKD). N‐terminal propeptide of collagen type 3 (PRO‐C3) is a biomarker of advanced fibrosis in MAFLD and PRO‐C3 may be involved in renal fibrosis. We aimed to use PRO‐C3 measurements to generate a new algorithmic score to test the prediction of MAFLD with chronic kidney disease (MAFLD–CKD).MethodsA derivation and independent validation cohort of 750 and 129 Asian patients with biopsy‐confirmed MAFLD were included. Serum PRO‐C3 concentration was measured and regression analyses were performed to examine associations with MAFLD–CKD. A derivative algorithm for MAFLD–CKD risk prediction was evaluated with receiver operator characteristic (ROC) curve analysis.ResultsThe study included two Asian cohorts (n = 180 with MAFLD–CKD; mean‐eGFR: 94.93 mL/min/1.73 m2; median‐urinary albumin‐to‐creatinine ratio: 6.58 mg/mmol). PRO‐C3 was associated with the severity of MAFLD‐CKD and independently associated with MAFLD–CKD (adjusted odds ratio = 1.16, 95% confidence interval [CI]: 1.08–1.23, p < .001). A new non‐invasive score (termed PERIOD) including PRO‐C3 efficiently predicted MAFLD‐CKD (AUROC = .842, 95% CI: .805–.875). Accuracy, specificity and negative predictive values were 80.2%, 85.1% and 88.4%, respectively. In the validation cohort, the PERIOD score had good diagnostic performance (AUROC = .807, 95% CI: .691–.893) with similar results in all patient subgroups. In the MAFLD–CKD subgroup, the accuracy for identifying advanced fibrosis was further improved by combining the PRO‐C3‐based ADAPT with the Agile 3+ scores (AUROC = .90, 95% CI: .836–.964).ConclusionsThe PERIOD score is helpful for accurately predicting the risk of MAFLD–CKD. PRO‐C3 can also be used to assess liver fibrosis in people with MAFLD–CKD.

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Section: Discussionmentioning

confidence: 99%

Serum PRO‐C3 is useful for risk prediction and fibrosis assessment in MAFLD with chronic kidney disease in an Asian cohort

Tang,

Sun,

Song

et al. 2024

Liver International

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“…The association between MAFLD and CKD occurrence has been supported by mechanistic as well as cohort studies. 10 , 20 However, possibly due to incomplete adjusting for confounders, the increased risk of CKD in participants with MAFLD ranges from 27% to 64%. 10 It is worth noting that although MAFLD and MASLD involve metabolic dysfunction at the time of diagnosis, the primary purpose of doing so is to identify metabolic dysfunction as the primary cause of hepatic steatosis rather than to diagnose the metabolic syndrome or predict the risk of cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 20 However, possibly due to incomplete adjusting for confounders, the increased risk of CKD in participants with MAFLD ranges from 27% to 64%. 10 It is worth noting that although MAFLD and MASLD involve metabolic dysfunction at the time of diagnosis, the primary purpose of doing so is to identify metabolic dysfunction as the primary cause of hepatic steatosis rather than to diagnose the metabolic syndrome or predict the risk of cardiovascular events. Therefore, we adjusted for factors such as diabetes and hypertension in order to highlight the impact of hepatic steatosis on CKD occurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, most studies suggested that MAFLD is an independent risk factor for CKD. 10 , 11 Hepatic steatosis, as a necessary condition for the diagnosis of MAFLD/MASLD, inevitably varies among patients, but no study has investigated the relationship between the severity of hepatic steatosis in MAFLD/MASLD and CKD occurrence. In addition, as a curable disease, 12 no study has investigated the relationship between remission of MAFLD/MASLD and CKD occurrence.…”

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confidence: 99%

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Severity and Remission of Metabolic Dysfunction–Associated Fatty/Steatotic Liver Disease With Chronic Kidney Disease Occurrence

Gao,

Li,

Zhang

et al. 2024

JAHA

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Background The association of the severity of hepatic steatosis in metabolic dysfunction–associated fatty liver disease (MAFLD)/metabolic dysfunction–associated steatotic liver disease (MASLD) and the remission of MAFLD/MASLD with CKD occurrence is unclear. Methods and Results The study enrolled 79 540 participants from the Kailuan cohort. Hepatic steatosis was diagnosed by ultrasound. MAFLD/MASLD was defined as hepatic steatosis combined with metabolic dysfunction and MASLD further excluded alcohol or other causes of liver disease. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate<60 mL/min per 1.73 m 2 or positive proteinuria (≥1+). Hazard ratio (HR) was calculated by Cox regression models. After a median follow‐up of 12.9 years, CKD occurred in 20 465 participants. After adjusting for potential confounders, MAFLD was associated with a higher risk of CKD compared with non‐MAFLD (HR, 1.12 [95% CI, 1.09–1.16]), and this risk increased with increasing severity of hepatic steatosis ( P ‐trend<0.001). Consistent findings were observed when MASLD was used as the exposure. Compared with persistent non‐MAFLD, no statistical difference was found in the risk of CKD in MAFLD remission (HR, 1.04 [95% CI, 0.95–1.15]); however, MASLD remission still had a higher risk of CKD compared with persistent non‐MASLD (HR, 1.15 [95% CI, 1.03–1.27]). When grouped according to the prior severity of hepatic steatosis, there was no statistically significant difference in risk of CKD in mild‐MAFLD/MASLD remission compared with persistent non‐MAFLD/MASLD, but moderated/severe‐MAFLD/MASLD remission still had a higher risk. Conclusions The risk of CKD in patients with MAFLD/MASLD increased with the severity of hepatic steatosis. Even after remission of the disease, patients with MAFLD/MASLD with prior moderate to severe hepatic steatosis still had a higher risk of CKD.

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“…The etiology of CKD is multifactorial, involving both non-modifiable factors such as age and genetic predisposition, as well as modifiable factors such as diabetes mellitus, hypertension, and obesity, which are also the metabolic risk factors shared with MAFLD 6 . Several studies have demonstrated that individuals with MAFLD are more likely to have and develop CKD compared with those without MAFLD 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Associations between metabolic dysfunction-associated fatty liver disease, chronic kidney disease, and abdominal obesity: a national retrospective cohort study

Cen,

Fan,

Ding

et al. 2024

Sci Rep

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Metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD) present notable health challenges, however, abdominal obesity has received scant attention despite its potential role in exacerbating these conditions. Thus, we conducted a retrospective cohort study using the National Health and Nutrition Examination Surveys III (NHANES III) of the United States from 1988 to 1994 including 9161 participants, and mortality follow-up survey in 2019. Statistical analyze including univariable and multivariable Logistic and Cox regression models, and Mediation effect analyze were applied in study after adjustment for covariates. Our findings revealed that individuals with both abdominal obesity and MAFLD were more likely to be female, older and exhibit higher prevalence of advanced liver fibrosis (7.421% vs. 2.363%, p < 0.001), type 2 diabetes mellitus (T2DM) (21.484% vs. 8.318%, p < 0.001) and CKD(30.306% vs. 16.068%, p < 0.001) compared to those with MAFLD alone. MAFLD (adjusted OR: 1.392, 95% CI 1.013–1.913, p = 0.041), abdominal obesity (adjusted OR 1.456, 95% CI 1.127–1.880, p = 0.004), abdominal obesity with MAFLD (adjusted OR 1.839, 95% CI 1.377–2.456, p < 0.001), advanced fibrosis(adjusted OR 1.756, 95% CI 1.178–2.619, p = 0.006) and T2DM (adjusted OR 2.365, 95% CI 1.758–3.183, p < 0.001) were independent risk factors of CKD. The abdominal obese MAFLD group had the highest all-cause mortality as well as mortality categorized by disease during the 30-year follow-up period. Indices for measuring abdominal obesity, such as waist circumference (WC), waist-hip ratio (WHR), and lipid accumulation product (LAP), elucidated a greater mediation effect of MAFLD on CKD compared to BMI on CKD (proportion mediation 65.23%,70.68%, 71.98%, respectively vs. 32.63%). In conclusion, the coexistence of abdominal obesity and MAFLD increases the prevalence and mortality of CKD, and abdominal obesity serves as a mediator in the association between MAFLD and CKD.

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The association between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: A systematic review and meta-analysis

Cited by 12 publications

References 41 publications

Serum PRO‐C3 is useful for risk prediction and fibrosis assessment in MAFLD with chronic kidney disease in an Asian cohort

Serum PRO‐C3 is useful for risk prediction and fibrosis assessment in MAFLD with chronic kidney disease in an Asian cohort

Severity and Remission of Metabolic Dysfunction–Associated Fatty/Steatotic Liver Disease With Chronic Kidney Disease Occurrence

Associations between metabolic dysfunction-associated fatty liver disease, chronic kidney disease, and abdominal obesity: a national retrospective cohort study

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