Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
Nephrol Dial Transplant. 2019 Mar 1;34(3):449-457. doi: 10.1093/ndt/gfx381.
Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor associated with cardiovascular disease (CVD) and incidence of chronic kidney disease (CKD). NAFLD is threatening to become a major public health problem in association with the metabolic syndrome. The association of NAFLD with outcomes in patients with advanced CKD has not been evaluated. In this study, the prevalence of NAFLD and its impact on cardiovascular and renal outcomes and mortality were determined in a large secondary care CKD cohort.
The study was conducted on 1148 CKD patients within a cohort of 3061 CKD patients, who had undergone ultrasound imaging of the liver over a 15-year period. A propensity-matched population from within the cohort was also included. Cox regression analysis was used to study the association of NAFLD with cardiovascular events, end-stage renal disease and mortality and linear regression analysis for CKD progression.
The prevalence of NAFLD was 17.9%. The median duration of follow-up after scanning was 5.4 years, with a median estimated glomerular filtration rate (eGFR) of 33.5 mL/min/1.73 m2 in this population. NAFLD proved to be a strong independent risk factor for cardiovascular events [hazard ratio (HR) 2.03; 95% confidence interval (CI) 1.33-3.13; P < 0.01] but it was not associated with all-cause mortality (HR 0.79; 95% CI 0.58-1.08; P = 0.14) or CKD progression (P = 0.09 for rate of decline of eGFR slope). Patients with CKD are known to have high cardiovascular risk; the propensity-matched analysis showed that NAFLD increased this cardiovascular risk (HR 2.00; CI 1.10-3.66; P < 0.05).
NAFLD has a strong independent association with cardiovascular events, even in an advanced CKD cohort with high comorbidity. The implication is that routine screening for NAFLD may be warranted in CKD populations to enable targeted interventions for CVD prevention in higher risk patients.
非酒精性脂肪性肝病（NAFLD）是与心血管疾病（CVD）和慢性肾脏病（CKD）发病率相关的独立危险因素。随着代谢综合征的出现，NAFLD 正在成为一个主要的公共卫生问题。NAFLD 与晚期 CKD 患者的结局之间的关系尚未得到评估。在这项研究中，我们在一个大型的二级保健 CKD 队列中评估了 NAFLD 的患病率及其对心血管和肾脏结局及死亡率的影响。
在一项 3061 例 CKD 患者的队列中，对 1148 例 CKD 患者进行了为期 15 年的肝脏超声检查。我们还纳入了队列内的倾向评分匹配人群。使用 Cox 回归分析研究 NAFLD 与心血管事件、终末期肾病和死亡率的关系，使用线性回归分析 CKD 进展。
NAFLD 的患病率为 17.9%。在扫描后中位随访 5.4 年，该人群的中位估算肾小球滤过率（eGFR）为 33.5ml/min/1.73m2。NAFLD 是心血管事件的一个强有力的独立危险因素[风险比（HR）2.03；95%置信区间（CI）1.33-3.13；P<0.01]，但与全因死亡率（HR 0.79；95%CI 0.58-1.08；P=0.14）或 CKD 进展（P=0.09 用于 eGFR 斜率的下降率）无关。患有 CKD 的患者已知具有较高的心血管风险；倾向评分匹配分析表明，NAFLD 增加了这种心血管风险（HR 2.00；CI 1.10-3.66；P<0.05）。
即使在患有高度合并症的晚期 CKD 队列中，NAFLD 也与心血管事件有很强的独立关联。这意味着在 CKD 人群中可能需要常规筛查 NAFLD，以便对高危患者进行有针对性的 CVD 预防干预。
