代谢相关脂肪性肝病比单纯性脂肪肝或非酒精性脂肪性肝病更能预测慢性肾脏病的发生。
Metabolic dysfunction-associated fatty liver disease predicts new onset of chronic kidney disease better than fatty liver or nonalcoholic fatty liver disease.
机构信息
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Tanaka Medical Clinic, Yoichi, Japan.
出版信息
Nephrol Dial Transplant. 2023 Feb 28;38(3):700-711. doi: 10.1093/ndt/gfac188.
BACKGROUND
Possible associations of chronic kidney disease (CKD) with fatty liver (FL) and nonalcoholic fatty liver disease (NAFLD) have recently been focused on. Metabolic dysfunction-associated fatty liver disease (MAFLD), defined as FL with overweight/obesity, type 2 diabetes mellitus or metabolic abnormalities, has been proposed as a new feature of chronic liver disease. However, the relationship between MAFLD and new onset of CKD has not been fully addressed.
METHODS
We investigated the associations of FL, NAFLD and MAFLD with the development of CKD, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or positive for urinary protein, over a 10-year period in 28 890 Japanese subjects who received annual health examinations. After exclusion of subjects with no data for abdominal ultrasonography and subjects with CKD at baseline, a total of 13 159 subjects (men 8581, women 4578; mean age 48 years) were recruited.
RESULTS
The prevalence of FL, NAFLD and MAFLD was 34.6% (men 45.1%, women 15.1%), 32.8% (men 42.7%, women 14.5%) and 32.3% (men 42.4%, women 13.4%), respectively. During the 10-year follow-up period, 2163 subjects (men 1475, women 688) had new onset of CKD. Multivariable Cox proportional hazards model analyses showed that MAFLD [hazard ratio 1.12 (95% confidence interval 1.02-1.26); P = .027] but not FL or NAFLD was an independent risk factor for new onset of CKD after adjustment of age, sex, eGFR, current smoking habit, ischemic heart disease, diabetes mellitus, overweight/obesity, hypertension and dyslipidemia. The addition of MAFLD [continuous net reclassification improvement (NRI) 0.154, integrated discrimination improvement (IDI) 0.0024] to traditional risk factors without metabolic abnormalities significantly improved the discriminatory capacity better than did the addition of FL (NRI 0.138, IDI 0.0018) or NAFLD (NRI 0.132, IDI 0.0017).
CONCLUSIONS
MAFLD is modestly and independently associated with new onset of CKD and predicts the risk for development of CKD better than FL or NAFLD.
背景
慢性肾脏病（CKD）与脂肪肝（FL）和非酒精性脂肪性肝病（NAFLD）之间可能存在关联，最近引起了关注。代谢功能障碍相关脂肪性肝病（MAFLD）定义为超重/肥胖、2 型糖尿病或代谢异常伴 FL，被认为是慢性肝病的一种新特征。然而，MAFLD 与新发 CKD 之间的关系尚未得到充分阐明。
方法
我们在 28890 名接受年度体检的日本受试者中，研究了 FL、NAFLD 和 MAFLD 与 10 年内 CKD（定义为估算肾小球滤过率[eGFR]＜60ml/min/1.73m2 或尿蛋白阳性）发展之间的关系。排除腹部超声检查无数据和基线时 CKD 的受试者后，共纳入 13159 名受试者（男性 8581 名，女性 4578 名；平均年龄 48 岁）。
结果
FL、NAFLD 和 MAFLD 的患病率分别为 34.6%（男性 45.1%，女性 15.1%）、32.8%（男性 42.7%，女性 14.5%）和 32.3%（男性 42.4%，女性 13.4%）。在 10 年随访期间，2163 名受试者（男性 1475 名，女性 688 名）新发 CKD。多变量 Cox 比例风险模型分析显示，MAFLD（危险比 1.12[95%置信区间 1.02-1.26]；P=0.027）而不是 FL 或 NAFLD 是调整年龄、性别、eGFR、当前吸烟习惯、缺血性心脏病、糖尿病、超重/肥胖、高血压和血脂异常后新发 CKD 的独立危险因素。与无代谢异常的传统危险因素相比，MAFLD 的加入（连续净重新分类改善[NRI]0.154，综合鉴别改善[IDI]0.0024）显著提高了 CKD 发生风险的预测能力，优于 FL（NRI 0.138，IDI 0.0018）或 NAFLD（NRI 0.132，IDI 0.0017）的加入。
结论
MAFLD 与新发 CKD 呈适度且独立相关，预测 CKD 发病风险优于 FL 或 NAFLD。
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