Development of chronic kidney disease in patients with non-alcoholic fatty liver disease: A cohort study

Dong Hyun Sinn, Danbee Kang, Hye Ryoun Jang, Seonhye Gu, Soo Jin Cho, Seung Woon Paik, Seungho Ryu, Yoosoo Chang, Mariana Lazo-Elizondo, Eliseo Guallar, Juhee Cho, Geum Youn Gwak

Research output: Contribution to journalArticle

Abstract

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods: We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9. y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results: The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60ml/min/1.73m2. During 200,790 person-years of follow-up (median follow-up of 4.15years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04-1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS <-1.455 and those with NFS ≥-1.455 to participants without NAFLD were 1.09 (95% CI 0.91-1.32) and 1.58 (95% CI 1.30-1.92), respectively. The association was consistent across clinically relevant subgroups. Conclusion: In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD. Lay summary: The presence of fatty liver is associated with the future decline of renal function. Thus, fatty liver patients need to be monitored regularly for renal function.

Original languageEnglish (US)
JournalJournal of Hepatology
DOIs
StateAccepted/In press - 2017

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Chronic Renal Insufficiency
Cohort Studies
Fatty Liver
Confidence Intervals
Kidney
Non-alcoholic Fatty Liver Disease
Fibrosis
Glomerular Filtration Rate
Liver Cirrhosis
Ultrasonography
Retrospective Studies

Keywords

  • Chronic kidney disease
  • Cohort
  • Fatty liver
  • Liver fibrosis

ASJC Scopus subject areas

  • Hepatology

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Development of chronic kidney disease in patients with non-alcoholic fatty liver disease : A cohort study. / Sinn, Dong Hyun; Kang, Danbee; Jang, Hye Ryoun; Gu, Seonhye; Cho, Soo Jin; Paik, Seung Woon; Ryu, Seungho; Chang, Yoosoo; Lazo-Elizondo, Mariana; Guallar, Eliseo; Cho, Juhee; Gwak, Geum Youn.

In: Journal of Hepatology, 2017.

Research output: Contribution to journalArticle

Sinn, Dong Hyun ; Kang, Danbee ; Jang, Hye Ryoun ; Gu, Seonhye ; Cho, Soo Jin ; Paik, Seung Woon ; Ryu, Seungho ; Chang, Yoosoo ; Lazo-Elizondo, Mariana ; Guallar, Eliseo ; Cho, Juhee ; Gwak, Geum Youn. / Development of chronic kidney disease in patients with non-alcoholic fatty liver disease : A cohort study. In: Journal of Hepatology. 2017.
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abstract = "Background & Aims: Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods: We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9. y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results: The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60ml/min/1.73m2. During 200,790 person-years of follow-up (median follow-up of 4.15years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95{\%} confidence interval [CI] 1.04-1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS <-1.455 and those with NFS ≥-1.455 to participants without NAFLD were 1.09 (95{\%} CI 0.91-1.32) and 1.58 (95{\%} CI 1.30-1.92), respectively. The association was consistent across clinically relevant subgroups. Conclusion: In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD. Lay summary: The presence of fatty liver is associated with the future decline of renal function. Thus, fatty liver patients need to be monitored regularly for renal function.",
keywords = "Chronic kidney disease, Cohort, Fatty liver, Liver fibrosis",
author = "Sinn, {Dong Hyun} and Danbee Kang and Jang, {Hye Ryoun} and Seonhye Gu and Cho, {Soo Jin} and Paik, {Seung Woon} and Seungho Ryu and Yoosoo Chang and Mariana Lazo-Elizondo and Eliseo Guallar and Juhee Cho and Gwak, {Geum Youn}",
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T1 - Development of chronic kidney disease in patients with non-alcoholic fatty liver disease

T2 - A cohort study

AU - Sinn, Dong Hyun

AU - Kang, Danbee

AU - Jang, Hye Ryoun

AU - Gu, Seonhye

AU - Cho, Soo Jin

AU - Paik, Seung Woon

AU - Ryu, Seungho

AU - Chang, Yoosoo

AU - Lazo-Elizondo, Mariana

AU - Guallar, Eliseo

AU - Cho, Juhee

AU - Gwak, Geum Youn

PY - 2017

Y1 - 2017

N2 - Background & Aims: Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods: We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9. y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results: The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60ml/min/1.73m2. During 200,790 person-years of follow-up (median follow-up of 4.15years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04-1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS <-1.455 and those with NFS ≥-1.455 to participants without NAFLD were 1.09 (95% CI 0.91-1.32) and 1.58 (95% CI 1.30-1.92), respectively. The association was consistent across clinically relevant subgroups. Conclusion: In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD. Lay summary: The presence of fatty liver is associated with the future decline of renal function. Thus, fatty liver patients need to be monitored regularly for renal function.

AB - Background & Aims: Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods: We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9. y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results: The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60ml/min/1.73m2. During 200,790 person-years of follow-up (median follow-up of 4.15years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04-1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS <-1.455 and those with NFS ≥-1.455 to participants without NAFLD were 1.09 (95% CI 0.91-1.32) and 1.58 (95% CI 1.30-1.92), respectively. The association was consistent across clinically relevant subgroups. Conclusion: In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD. Lay summary: The presence of fatty liver is associated with the future decline of renal function. Thus, fatty liver patients need to be monitored regularly for renal function.

KW - Chronic kidney disease

KW - Cohort

KW - Fatty liver

KW - Liver fibrosis

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