Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease
Chao Sun a , George Boon-Bee Goh b , Wan-Cheng Chow b , Wah-Kheong Chan c , Grace Lai-Hung Wong d , Wai-Kay Seto e , Yi-Hsiang Huang f , g , Han-Chieh Lin g , h , I-Cheng Lee g , h , Hye Won Lee i , Seung Up Kim i , Vincent Wai-Sun Wong d , ∗, Jian-Gao Fan a , ∗
a Center for Fatty Liver Disease, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China
b Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
c Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
d Department of Medicine and Therapeutics and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
e Department of Medicine, The University of Hong Kong, Hong Kong, China
f Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, China
g Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan, China
h Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, China
i Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Abstract：Background: Nonalcoholic fatty liver disease (NAFLD) is associated with impaired renal function, and both diseases often occur alongside other metabolic disorders. However, the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear. The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.
Methods: All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography ex- amination from eight Asian centers were enrolled in this prospective study. Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase (FAST), Agile 3+ and Agile 4 scores. Impaired renal function and chronic kidney disease (CKD) were defined by an estimated glomerular filtration rate (eGFR) with value of < 90 mL/min/1.73 m2 and < 60 mL/min/1.73 m2 , respectively, as estimated by the CKD-Epidemiology Collaboration (CKD-EPI) equation.
Results: Among 529 included NAFLD patients, the prevalence rates of impaired renal function and CKD were 37.4% and 4.9%, respectively. In multivariate analysis, a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+ and Agile 4 scores were independent risk factors for CKD ( P < 0.05). Furthermore, increased fasting plasma glucose (FPG) and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome ( P < 0.05). Compared with patients with normoglycemia, those with prediabetes [FPG ≥5.6 mmol/L or hemoglobin A1c (HbA1c) ≥5.7%] were more likely to have impaired renal function ( P < 0.05).
Conclusions: Agile 3+ and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD. Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.
. [J]. Hepatobiliary Pancreat Dis Int, 2024, 23(3): 241-248.
Sun C, Goh GB, Chow WC, Chan WK, Wong GL, Seto WK, Huang YH, Lin HC, Lee IC, Lee HW, Kim SU, Wong VW, Fan JG. Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease. Hepatobiliary Pancreat Dis Int, 2024, 23(3): 241-248.
2024, Vol. 23 
