Center for Nephrology "G. Papadakis," General Hospital of Nikaia-Piraeus "Agios Panteleimon," Nikaia 18454, Greece.
World J Gastroenterol. 2022 Oct 21;28(39):5691-5706. doi: 10.3748/wjg.v28.i39.5691.
The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease (MAFLD) has resulted in the reappraisal of epidemiological trends and associations with other chronic diseases. In this context, MAFLD appears to be tightly linked to incident chronic kidney disease (CKD). This association may be attributed to multiple shared risk factors including type 2 diabetes mellitus, arterial hypertension, obesity, dyslipidemia, and insulin resistance. Moreover, similarities in their molecular pathophysiologic mechanisms can be detected, since inflammation, oxidative stress, fibrosis, and gut dysbiosis are highly prevalent in these pathologic states. At the same time, lines of evidence suggest a genetic predisposition to MAFLD due to gene polymorphisms, such as the rs738409 G allele polymorphism, which may also propagate renal dysfunction. Concerning their management, available treatment considerations for obesity (bariatric surgery) and novel antidiabetic agents (glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter 2 inhibitors) appear beneficial in preclinical and clinical studies of MAFLD and CKD modeling. Moreover, alternative approaches such as melatonin supplementation, farnesoid X receptor agonists, and gut microbiota modulation may represent attractive options in the future. With a look to the future, additional adequately sized studies are required, focusing on preventing renal complications in patients with MAFLD and the appropriate management of individuals with concomitant MAFLD and CKD.
最近提出的将非酒精性脂肪性肝病的命名更改为代谢功能障碍相关脂肪性肝病(MAFLD),导致对其流行病学趋势和与其他慢性疾病的关联进行重新评估。在这种情况下,MAFLD 似乎与慢性肾脏病(CKD)的发生密切相关。这种关联可能归因于多种共同的危险因素,包括 2 型糖尿病、动脉高血压、肥胖、血脂异常和胰岛素抵抗。此外,由于炎症、氧化应激、纤维化和肠道菌群失调在这些病理状态中非常普遍,因此可以发现它们在分子病理生理机制方面存在相似之处。同时,有证据表明 MAFLD 存在遗传易感性,这是由于基因多态性引起的,例如 rs738409 G 等位基因多态性,这也可能导致肾功能障碍。在治疗方面,肥胖症(减重手术)和新型抗糖尿病药物(胰高血糖素样肽 1 受体激动剂、钠-葡萄糖共转运蛋白 2 抑制剂)的现有治疗考虑因素似乎对 MAFLD 和 CKD 模型的临床前和临床研究有益。此外,其他方法,如褪黑素补充剂、法尼醇 X 受体激动剂和肠道微生物群调节,可能在未来具有吸引力。展望未来,需要进行更多适当规模的研究,重点是预防 MAFLD 患者的肾脏并发症,以及对同时患有 MAFLD 和 CKD 的个体进行适当的管理。
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