Endocrinology and Metabolism, University of Verona Department of Medicine, Verona, Veneto, Italy.
Internal Medicine, University of Modena and Reggio Emilia Faculty of Medicine and Surgery, Modena, Emilia-Romagna, Italy.
Gut. 2022 Jan;71(1):156-162. doi: 10.1136/gutjnl-2020-323082. Epub 2020 Dec 10.
Studies reported a significant association between non-alcoholic fatty liver disease (NAFLD) and increased risk of chronic kidney disease (CKD). However, whether this risk changes with increasing severity of NAFLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and risk of incident CKD.
We systematically searched PubMed, Web of Science and Scopus from January 2000 to August 2020 using predefined keywords to identify observational studies with a follow-up duration of ≥1 year, in which NAFLD was diagnosed by blood biomarkers/scores, International Classification of Diseases codes, imaging techniques or biopsy. Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling.
13 studies with 1 222 032 individuals (28.1% with NAFLD) and 33 840 cases of incident CKD stage ≥3 (defined as estimated glomerular filtration rate <60 mL/min/1.73 m, with or without accompanying overt proteinuria) over a median follow-up of 9.7 years were included. NAFLD was associated with a moderately increased risk of incident CKD (n=10 studies; random-effects HR 1.43, 95% CI 1.33 to 1.54; =60.7%). All risks were independent of age, sex, obesity, hypertension, diabetes and other conventional CKD risk factors. Sensitivity analyses did not alter these findings. Funnel plot did not reveal any significant publication bias.
This large and updated meta-analysis indicates that NAFLD is significantly associated with a~1.45-fold increased long-term risk of incident CKD stage ≥3. Further studies are needed to examine the association between the severity of NAFLD and risk of incident CKD.
研究报告称，非酒精性脂肪性肝病（NAFLD）与慢性肾脏病（CKD）风险增加之间存在显著关联。然而，这种风险是否会随着 NAFLD 严重程度的增加而变化尚不确定。我们对观察性研究进行了荟萃分析，以量化 NAFLD 与新发 CKD 风险之间的关联程度。
我们系统地检索了 PubMed、Web of Science 和 Scopus，使用预定义的关键字，从 2000 年 1 月至 2020 年 8 月进行了检索，以确定随访时间≥1 年的观察性研究，其中 NAFLD 通过血液生物标志物/评分、国际疾病分类代码、成像技术或活检进行诊断。从选定的研究中提取数据，并使用随机效应模型进行荟萃分析。
共纳入 13 项研究，包含 1222032 名个体（28.1%患有 NAFLD）和 33840 例新发 CKD 期≥3 例（定义为估算肾小球滤过率<60mL/min/1.73m，伴有或不伴有明显蛋白尿），中位随访时间为 9.7 年。NAFLD 与新发 CKD 的风险中度增加相关（n=10 项研究；随机效应 HR 1.43，95%CI 1.33 至 1.54； =60.7%）。所有风险均与年龄、性别、肥胖、高血压、糖尿病和其他传统 CKD 风险因素无关。敏感性分析并未改变这些发现。漏斗图未显示任何显著的发表偏倚。
这项大规模且更新的荟萃分析表明，NAFLD 与新发 CKD 期≥3 的长期风险增加约 1.45 倍显著相关。需要进一步研究来检查 NAFLD 严重程度与新发 CKD 风险之间的关联。
