Liver and Bile
Gut. 2022;71(1):156–62
Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: An updated meta-analysis
Objective: Studies reported a significant association between non-alcoholic fatty liver disease (NAFLD) and increased risk of chronic kidney disease (CKD). However, whether this risk changes with increasing severity of NAFLD remains uncertain. The authors performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and risk of incident CKD.
Design: They systematically searched PubMed, Web of Science and Scopus from January 2000 to August 2020 using predefined keywords to identify observational studies with a follow-up duration of ≥ 1 year, in which NAFLD was diagnosed by blood biomarkers/scores, International Classification of Diseases codes, imaging techniques or biopsy. Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling.
Results: 13 studies with 1,222,032 individuals (28.1% with NAFLD) and 33,840 cases of incident CKD stage ≥ 3 (defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2, with or without accompanying overt proteinuria) over a median follow-up of 9.7 years were included. NAFLD was associated with a moderately increased risk of incident CKD (n = 10 studies; random-effects HR = 1.43, 95% confidence interval: 1.33–1.54; I2 = 60.7%). All risks were independent of age, sex, obesity, hypertension, diabetes and other conventional CKD risk factors. Sensitivity analyses did not alter these findings. Funnel plot did not reveal any significant publication bias.
Conclusion: This large and updated meta-analysis indicates that non-alcoholic fatty liver disease (NAFLD) is significantly associated with a ~1.45-fold increased long-term risk of incident chronic kidney disease (CKD) stage ≥ 3. Further studies are needed to examine the association between the severity of NAFLD and risk of incident CKD.