Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy.
Unit of Internal Medicine and Metabolic Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Int J Mol Sci. 2022 Jun 23;23(13):7007. doi: 10.3390/ijms23137007.
Accumulating evidence now indicates that non-alcoholic fatty liver disease (NAFLD), which is the most common chronic liver disease observed in clinical practice worldwide, is independently associated with an increased risk of incident chronic kidney disease (CKD). Given that NAFLD is linked to insulin resistance, obesity and type 2 diabetes mellitus, an international panel of experts have recently proposed a name change from NAFLD to metabolic associated fatty liver disease (MAFLD). Since the diagnostic criteria for NAFLD and MAFLD are different, observational studies assessing the potential concordance (or even superiority) of MAFLD, compared with NAFLD, in detecting patients at increased risk of hepatic and extra-hepatic complications (including CKD) are required. Hence, in the last two years, some observational studies have investigated the potential relationship between MAFLD and CKD. The result is that, at present, evidence regarding the concordance or even superiority of MAFLD, compared with NAFLD, in detecting patients at higher risk of CKD is still preliminary, although some data indicate that MAFLD identifies patients with CKD as accurately as NAFLD. In this narrative review, we will discuss: (a) the epidemiological evidence assessing the association between NAFLD and risk of incident CKD, (b) the epidemiological data investigating the association between MAFLD and risk of CKD and (c) the biological mechanisms underlying the association between NAFLD/MAFLD and CKD.
越来越多的证据表明，非酒精性脂肪性肝病（NAFLD）是世界范围内临床实践中最常见的慢性肝病，与慢性肾脏病（CKD）的发病风险增加独立相关。由于 NAFLD 与胰岛素抵抗、肥胖和 2 型糖尿病有关，一个国际专家小组最近提议将其名称从 NAFLD 更改为代谢相关脂肪性肝病（MAFLD）。由于 NAFLD 和 MAFLD 的诊断标准不同，需要进行观察性研究来评估 MAFLD 与 NAFLD 相比在检测肝和肝外并发症（包括 CKD）风险增加的患者方面的潜在一致性（甚至优越性）。因此，在过去两年中，一些观察性研究已经调查了 MAFLD 与 CKD 之间的潜在关系。结果是，目前，关于 MAFLD 与 NAFLD 相比在检测 CKD 风险较高患者方面的一致性甚至优越性的证据仍然初步，尽管一些数据表明 MAFLD 能够像 NAFLD 一样准确地识别 CKD 患者。在本叙述性综述中，我们将讨论：（a）评估 NAFLD 与 CKD 发病风险之间关联的流行病学证据，（b）调查 MAFLD 与 CKD 风险之间关联的流行病学数据，以及（c）NAFLD/MAFLD 与 CKD 之间关联的潜在生物学机制。
