The Development of Chronic Kidney Disease in Japanese Patients with Non-alcoholic Fatty Liver Disease

Abstract

Objective Chronic kidney disease (CKD) is present in patients with nonalcoholic fatty liver disease (NAFLD). The aim of this retrospective study was to assess the cumulative development incidence and predictive factors for new onset of CKD in Japanese patients with NAFLD. Methods A total of 5,561 NAFLD patients without CKD were enrolled. CKD was defined as either an estimated glomerular filtration rate of <60 mL/min/1.73 m 2 or dipstick proteinuria (! 1). A blood sample and a urine sample were taken for routine analyses during follow-up. The mean observation period was 5.5 years. The primary goal is the new development of CKD. Independent factors associated with new development of CKD were analyzed by using the Kaplan-Meyer method and the Cox proportional hazards model. Results Of 5.561 NAFLD patients, 263 patients developed CKD. The cumulative development rate of CKD was 3.1% at the 5th year and 12.2% at the 10th year. Multivariate Cox proportional hazards analysis showed that CKD development in patients with NAFLD occurred when patient had low level of GFR of 60-75 mL/ min/1.73 m 2 [hazard ratio:2.75; 95% confidence interval (CI) =1.93-3.94; p<0.001], age of !50 years (hazard ratio: 2.67; 95% CI=2.06-3.46; p<0.001), diabetes (hazard ratio: 1.92; 95% CI=1.45-2.54; p<0.001), hypertension (hazard ratio: 1.69; 95% CI=1.25-2.29; p<0.001), and elevated serum gamma-glutamyltransferase of !109 IU/L(hazard ratio: 1.35; 95% CI=1.02-1.78; p=0.038). Conclusion Our retrospective study indicates that the annual incidence of CKD in Japanese patients with NAFLD is about 1.2%. Five factors of low eGFR level, aging, type 2 diabetes, hypertension, and elevated gamma-glutamyltransferase, increases the risk of the development of CKD.

Nonalcoholic fatty liver disease and vascular risk

“…Importantly, CKD is also an independent risk factor for CVD [38]. In a large retrospective cohort study of Japanese patients with NAFLD, the annual incidence of CKD was 1.2% over a 10-year follow-up period [39]. Unsurprisingly, diabetes and hypertension at baseline were among some of the factors significantly associated with the development of CKD.…”

Efficacy and safety in sitagliptin therapy for diabetes complicated by non‐alcoholic fatty liver disease

“…In particular, patients with NAFLD tend to develop T2DM. NAFLD patients with T2DM enhance a major risk for malignancies including HCC, vascular disease and chronic kidney disease . Thus, in patients with T2DM and NAFLD, the good management of T2DM is very important to improve the prolonged prognosis.…”

“…NAFLD patients with T2DM enhance a major risk for malignancies including HCC, vascular disease and chronic kidney disease. 14,15,19,20 Thus, in patients with T2DM and NAFLD, the good management of T2DM is very important to improve the prolonged prognosis. Generally, most oral hypoglycemic agents (thiazolidines, sulfonylurea and biguanides) are metabolized in the liver.…”

“…NAFLD is considered to be the liver component of metabolic syndrome . It is associated with obesity, dyslipidemia, pituitary dysfunction, hypertension, sleeping apnea, chronic kidney disease and vascular disease . Lately, it has been reported that patients with NAFLD are associated with type 2 diabetes mellitus (T2DM) .…”

“…[7][8][9] It is associated with obesity, dyslipidemia, pituitary dysfunction, hypertension, sleeping apnea, chronic kidney disease and vascular disease. [10][11][12][13][14][15] Lately, it has been reported that patients with NAFLD are associated with type 2 diabetes mellitus (T2DM). [16][17][18] Moreover, T2DM has been suggested to enhance with the development of hepatocellular carcinoma (HCC) and malignancies other than HCC.…”