Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
J Formos Med Assoc. 2020 Jan;119(1 Pt 1):42-50. doi: 10.1016/j.jfma.2019.02.010. Epub 2019 Mar 12.
BACKGROUND/PURPOSE: The impact of non-alcoholic fatty liver disease (NAFLD) on the prevalence of chronic kidney disease (CKD) is not fully elucidated. We aimed to assess the correlation between NAFLD and CKD in a large population study.
We included consecutive subjects who had received health check-up service at Taipei Veterans General Hospital from 2002 to 2009. NAFLD was diagnosed with abdominal ultrasound, and advanced liver fibrosis was determined with NAFLD fibrosis score (NAFLD-FS). CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m.
Among the 29,797 subjects enrolled in this study, NAFLD and CKD were diagnosed in 44.5% and 20.2% of the population, respectively. Subjects with NAFLD had a higher proportion of CKD compared to those without NAFLD (24.1% vs. 17.1%, p < 0.001). However, NAFLD was not related to CKD with an odds ratio (OR) of 1.015 (95% confidence interval [CI] 0.954-1.081, p = 0.630) after multivariate analyses. Nevertheless, further analyses revealed that among patients with NAFLD, those with advanced fibrosis were more likely to have CKD after adjusting for confounding factors (OR 2.284, 95% CI 1.513-3.448, p < 0.001).
NAFLD per se was not a risk factor for CKD, but NAFLD patients with advanced fibrosis faced a higher possibility of CKD. Hence, patients with NAFLD and advanced fibrosis should be screened for CKD and prompted to receive treatment if the diagnosis was made.
背景/目的：非酒精性脂肪性肝病（NAFLD）对慢性肾脏病（CKD）患病率的影响尚未完全阐明。本研究旨在一项大型人群研究中评估 NAFLD 与 CKD 之间的相关性。
我们纳入了 2002 年至 2009 年在台北荣民总医院接受健康检查服务的连续患者。通过腹部超声诊断 NAFLD，并用 NAFLD 纤维化评分（NAFLD-FS）确定晚期肝纤维化。CKD 定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m。
在本研究纳入的 29797 名患者中，分别有 44.5%和 20.2%的患者诊断为 NAFLD 和 CKD。与无 NAFLD 的患者相比，有 NAFLD 的患者更易患有 CKD（24.1% vs. 17.1%，p<0.001）。然而，经过多变量分析，NAFLD 与 CKD 无关，比值比（OR）为 1.015（95%置信区间 [CI] 0.954-1.081，p=0.630）。然而，进一步分析表明，在患有 NAFLD 的患者中，在调整混杂因素后，纤维化程度较高的患者更有可能患有 CKD（OR 2.284，95% CI 1.513-3.448，p<0.001）。
NAFLD 本身不是 CKD 的危险因素，但纤维化程度较高的 NAFLD 患者患 CKD 的可能性更高。因此，患有 NAFLD 和晚期纤维化的患者应进行 CKD 的筛查，如果确诊应及时接受治疗。
