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, 48.9y) 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.

中文翻译：

---

非酒精性脂肪肝患者慢性肾脏病的发展：一项队列研究

背景和目的 非酒精性脂肪肝 (NAFLD) 与慢性肾病 (CKD) 相关，但队列研究有限。我们调查了 NAFLD 及其严重程度与 CKD 发展的纵向关联。方法 我们对 41,430 名基线时无 CKD 的成年男性和女性（平均年龄 48.9 岁）进行了一项回顾性队列研究，这些男性和女性在 2003 年 1 月 1 日至 2013 年 12 月 31 日期间接受了多次健康检查。通过超声检查评估 NAFLD 状态和 NAFLD 严重程度由 NAFLD 纤维化评分 (NFS) 评估。结果 结果是 CKD 发生，定义为估计肾小球滤过率低于 60ml/min/1.73m2。在 200,790 人年的随访中（中位随访时间为 4.15 年），我们确定了 691 例 CKD 病例。比较有和没有 NAFLD 的参与者的 CKD 多变量调整风险比为 1.22（95% 置信区间 [CI] 1.04-1.43）。随着 NAFLD 严重程度的增加，CKD 的风险逐渐增加。将 NFS <-1.455 的参与者和 NFS ≥-1.455 的参与者与非 NAFLD 的参与者进行比较的 CKD 的多变量调整风险比分别为 1.09 (95% CI 0.91-1.32) 和 1.58 (95% CI 1.30-1.92)。这种关联在临床相关亚组中是一致的。结论 在一大群没有 CKD 的成年男性和女性中，NAFLD 与 CKD 发展的风险增加有关。NAFLD 可能会对肾功能产生不利影响，因此可能需要仔细监测患者的 CKD 风险。概述 脂肪肝的存在与未来肾功能的下降有关。因此，