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This cross-sectional study of 13,915 adults investigated the association of nonalcoholic fatty liver disease (NAFLD) fibrosis and the development of chronic kidney disease (CKD). NAFLD fibrosis risk was associated with increased risk of CKD in patients with NAFLD, type 2 diabetes, and coexistent NAFLD and type 2 diabetes. The fibrosis index based on four factors was a stronger predictor of CKD incidence than the NAFLD fibrosis score.
NAFLD with increased risk of fibrosis and type 2 diabetes have an additive effect on CKD incidence; high-risk populations requiring aggressive CKD risk modification may be identified based on the coexistence of NAFLD and type 2 diabetes.
Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease, associated with fibrosis and an increased risk of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).
This work aimed to investigate the association of NAFLD fibrosis with the development of CKD in aged patients with T2DM.
This cross-sectional study enrolled 13 915 participants. A further 1734 individuals who had been followed annually for 5 years comprised the retrospective cohort study. Noninvasive markers, NAFLD fibrosis score (NFS), and fibrosis index based on 4 factors (FIB-4) were applied to determine NAFLD fibrosis risk.
In the cross-sectional study, there was an additive interaction for NAFLD with increased risk of fibrosis and T2DM on CKD incidence. Logistic regression demonstrated that as NAFLD fibrosis risk progressed from low to intermediate and high, there was a stepwise increase in CKD in patients with NAFLD, T2DM, and those with coexistent NAFLD and T2DM when stratified by diabetes and fibrosis stage. FIB-4 had a much higher odds ratio (OR) value than NFS for prediction of CKD incidence. In the cohort study, individuals were grouped according to FIB-4 and NFS. Cox regression analysis showed that FIB-4 intermediate risk (hazard ratio [HR] 1.268; 95% CI, 1.056-1.521) and high risk (HR 2.516; 95% CI, 1.970-3.214) were significant predictors of CKD progression. When NFS was applied, only high risk was a significant predictor.
NAFLD with an increased risk of fibrosis and presence of T2DM had an additive interaction on CKD incidence. Increased risk of NAFLD fibrosis was closely associated with CKD incidence and progression in aged T2DM patients. FIB-4 outperformed NFS as a noninvasive means to predict CKD development.