Advanced liver fibrosis measured by transient elastography predicts chronic kidney disease development in individuals with non-alcoholic fatty liver disease,Diabetologia

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Advanced liver fibrosis measured by transient elastography predicts chronic kidney disease development in individuals with non-alcoholic fatty liver disease
Diabetologia ( IF 8.4 ) Pub Date : 2021-12-21 , DOI: 10.1007/s00125-021-05627-9
Chan-Young Jung ₁ , Geun Woo Ryu ₁ , Hyung Woo Kim ₁ , Sang Hoon Ahn _{2,

3} , Seung Up Kim _{2,

3} , Beom Seok Kim ₁

Affiliation

Aims/hypothesis

Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are progressive chronic conditions that share important cardiometabolic risk factors and pathogenic mechanisms. We investigated the association between liver fibrosis measured by transient elastography (TE) and the risk of incident CKD in individuals with NAFLD.

Methods

A total of 5983 participants with NAFLD (defined as controlled attenuation parameter >222 dB/m) but without CKD who underwent TE between March 2012 and August 2018 were selected. The primary outcome was incident CKD, defined as the occurrence of eGFR <60 ml min⁻¹ [1.73 m]⁻² or proteinuria (≥1+ on dipstick test) on two consecutive measurements during follow-up. The secondary outcome was a 25% decline in eGFR measured on two consecutive visits.

Results

The mean age was 51.8 years and 3756 (62.8%) participants were male. During 17,801 person-years of follow-up (mean follow-up of 3.0 years), 62 participants (1.0%) developed incident CKD. When stratified into TE-defined fibrosis stages (F0–F4), multivariable Cox models revealed that risk of incident CKD was 5.40-fold (95% CI 2.46, 11.84; p < 0.001) higher in the F3/F4 group (≥9.5 kPa) than in the F0 group (<5.5 kPa). During 17,577 person-years of follow-up (mean follow-up of 3.0 years), 201 participants (3.4%) experienced the secondary outcome, for which the F3/F4 group had a 3.22-fold higher risk (95% CI 1.96, 5.28; p < 0.001) than the F0 group.

Conclusions/interpretation

In this large cohort of individuals with NAFLD but without baseline CKD, advanced liver fibrosis measured by TE was significantly associated with a higher risk of incident CKD.

Graphical abstract

中文翻译：

通过瞬时弹性成像测量的晚期肝纤维化可预测非酒精性脂肪肝患者的慢性肾病发展

目标/假设

非酒精性脂肪性肝病 (NAFLD) 和慢性肾病 (CKD) 是进行性慢性疾病，它们具有重要的心脏代谢危险因素和致病机制。我们调查了通过瞬时弹性成像 (TE) 测量的肝纤维化与 NAFLD 个体发生 CKD 的风险之间的关联。

方法

共选择了 5983 名在 2012 年 3 月至 2018 年 8 月期间接受 TE 的 NAFLD（定义为受控衰减参数 >222 dB/m）但没有 CKD 的参与者。主要结果是 CKD 事件，定义为在随访期间的两次连续测量中出现 eGFR <60 ml min ^-1 [1.73 m] ^{-2或蛋白尿（试纸测试≥1+）。}次要结果是连续两次就诊测量的 eGFR 下降 25%。

结果

平均年龄为 51.8 岁，3756 名（62.8%）参与者为男性。在 17,801 人年的随访期间（平均随访 3.0 年），62 名参与者（1.0%）发生 CKD。当分层为 TE 定义的纤维化阶段 (F0-F4) 时，多变量 Cox 模型显示F3/F4 组 (≥9.5 kPa)发生 CKD 的风险高 5.40 倍 (95% CI 2.46, 11.84; p < 0.001) ) 比 F0 组 (<5.5 kPa)。在 17,577 人年的随访期间（平均随访 3.0 年），201 名参与者（3.4%）经历了次要结局，其中 F3/F4 组的风险高出 3.22 倍（95% CI 1.96， 5.28；p < 0.001) 比 F0 组。