Arase Yasuji, Suzuki Fumitaka, Kobayashi Mariko, Suzuki Yoshiyuki, Kawamura Yusuke, Matsumoto Naoki, Akuta Norio, Kobayashi Masahiro, Sezaki Hitomi, Saito Satoshi, Hosaka Tetsuya, Ikeda Kenji, Kumada Hiromitsu, Ohmoto Yuki, Amakawa Kazuhisa, Tsuji Hiroshi, Hsieh Shiun Dong, Kato Kazuhisa, Tanabe Maho, Ogawa Kyoko, Hara Shigeko, Kobayashi Tetsuro
Department of Hepatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan.
Intern Med. 2011;50(10):1081-7. doi: 10.2169/internalmedicine.50.5043. Epub 2011 May 1.
Objective Chronic kidney disease (CKD) is present in patients with nonalcoholic fatty liver disease (NAFLD). The aim of this retrospective study was to assess the cumulative development incidence and predictive factors for new onset of CKD in Japanese patients with NAFLD. Methods A total of 5,561 NAFLD patients without CKD were enrolled. CKD was defined as either an estimated glomerular filtration rate of <60 mL/min/1.73 m(2) or dipstick proteinuria (≥+1). A blood sample and a urine sample were taken for routine analyses during follow-up. The mean observation period was 5.5 years. The primary goal is the new development of CKD. Independent factors associated with new development of CKD were analyzed by using the Kaplan-Meyer method and the Cox proportional hazards model. Results Of 5.561 NAFLD patients, 263 patients developed CKD. The cumulative development rate of CKD was 3.1% at the 5th year and 12.2% at the 10th year. Multivariate Cox proportional hazards analysis showed that CKD development in patients with NAFLD occurred when patient had low level of GFR of 60-75 mL/min/1.73 m(2) [hazard ratio:2.75; 95% confidence interval (CI)=1.93-3.94; p<0.001], age of ≥50 years (hazard ratio: 2.67; 95% CI=2.06-3.46; p<0.001), diabetes (hazard ratio: 1.92; 95% CI=1.45-2.54; p<0.001), hypertension (hazard ratio: 1.69; 95% CI=1.25-2.29; p<0.001), and elevated serum gamma-glutamyltransferase of ≥109 IU/L (hazard ratio: 1.35; 95% CI=1.02-1.78; p=0.038). Conclusion Our retrospective study indicates that the annual incidence of CKD in Japanese patients with NAFLD is about 1.2%. Five factors of low eGFR level, aging, type 2 diabetes, hypertension, and elevated gamma-glutamyltransferase, increases the risk of the development of CKD.
目的 慢性肾脏病（CKD）存在于非酒精性脂肪性肝病（NAFLD）患者中。本回顾性研究旨在评估日本NAFLD患者CKD新发的累积发生率及预测因素。方法 共纳入5561例无CKD的NAFLD患者。CKD定义为估算肾小球滤过率<60 mL/min/1.73 m²或尿试纸法蛋白尿（≥+1）。随访期间采集血样和尿样进行常规分析。平均观察期为5.5年。主要目标是CKD的新发。采用Kaplan - Meyer法和Cox比例风险模型分析与CKD新发相关的独立因素。结果 在5561例NAFLD患者中，263例发生了CKD。CKD的累积发生率在第5年为3.1%，第10年为12.2%。多因素Cox比例风险分析显示，NAFLD患者出现CKD的情况为：肾小球滤过率在60 - 75 mL/min/1.73 m²处于低水平时[风险比：2.75；95%置信区间（CI）=1.93 - 3.94；p<0.001]、年龄≥50岁（风险比：2.67；95% CI = 2.06 - 3.46；p<0.001）、糖尿病（风险比：1.92；95% CI = 1.45 - 2.54；p<0.001）、高血压（风险比：1.69；95% CI = 1.25 - 2.29；p<0.001）以及血清γ-谷氨酰转移酶升高≥109 IU/L（风险比：1.35；95% CI = 1.02 - 1.78；p = 0.038）。结论 我们的回顾性研究表明，日本NAFLD患者中CKD的年发病率约为1.2%。估算肾小球滤过率水平低、老龄化、2型糖尿病、高血压以及γ-谷氨酰转移酶升高这五个因素会增加CKD发生的风险。
