Non-alcoholic fatty liver disease (NAFLD) is associated with incident chronic kidney disease (CKD). We aimed to investigate outcomes and risk factors of CKD progression and regression.
This is a longitudinal community-based cohort study of patients with NAFLD. Exclusion criteria included alcoholic liver diseases, sero-positive for hepatitis B surface antigen, sero-positive for hepatitis C virus antibodies, fatty liver index < 60, individuals with only one year of data, missing data for fibrosis-4 score and NAFLD fibrosis score, and advanced CKD at baseline. Main outcomes were stratified according to eGFR and albuminuria categories as state 1 (low risk), state 2 (moderately increased risk), and state 3 (high-risk/very-high risk of progression). The multi-state Markov model was used for outcome analysis.
This study included 1,628 patients with NAFLD with a median follow-up of 3.4 years. State 2 CKD was found in 9.3% of patients at 5 years (95% CI, 8.1%-10.6%). Most patients with state 2 CKD recovered to state 1 (69%; 95% CI, 63.7%-74%), while 17.6% progressed to state 3 (95% CI, 13.4%- 22.7%). Advanced liver fibrosis was found to be associated with the risk of transitioning from state 1 to state 2 (Fibrosis-4 score ≥1.3; hazard ratio [HR], 1.42; 95% CI, 1.02-2.00), and reduced recovery from state 2 to state 1 (NAFLD fibrosis score; NFS≥-1.455; HR, 0.56; 95% CI, 0.34-0.91).
NAFLD severity is associated with CKD, which may be reversible before becoming high-risk. Controlling metabolic risk factors and preventing advanced liver fibrosis are recommended.

Copyright © 2022 Chang Gung University. Published by Elsevier B.V. All rights reserved.