School of Public Health, Fujian Medical University, Fuzhou, China.
Department of Ultrasonography, Fuqing Hospital, Fuqing, China.
Front Public Health. 2022 Nov 7;10:1047794. doi: 10.3389/fpubh.2022.1047794. eCollection 2022.
Although type 2 diabetes mellitus (T2DM) plays a significant role in the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD), how T2DM development and glycemic deterioration affect CKD and its renal function indicators, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), remains unknown. We aimed to assess the association between MAFLD, along with T2DM, and risk of CKD, and then evaluate the effect of metabolic goal achievement in MAFLD on the risk of CKD.
In this cross-sectional study, 5,594 participants were included. Multivariate logistic regression and linear regression were used to examine the association between MAFLD with its T2DM status and metabolic goal achievement and risk of CKD, as well as eGFR and UACR.
The MAFLD group had a higher prevalence of CKD (16.2 vs. 7.6%, < 0.001) than the non-MAFLD group. MAFLD was independently associated with an increased risk of CKD (odds ratio [OR]: 1.35, 95% CI: 1.09-1.67) and increased eGFR and UACR. Among the three MAFLD subtypes, only the T2DM subtype exhibited significant associations with increased risk of CKD (OR: 2.85, 95% CI: 2.24-3.63), as well as increased eGFR and UACR. Glycemic deterioration in MAFLD was dose-dependently associated with an increased risk of CKD (-trend < 0.001). Achieved metabolic goals in MAFLD decreased the risk of CKD, eGFR, and UACR; MAFLD with 2 or 3 achieved metabolic goals was not significantly associated with the risk of CKD (OR: 0.81, 95% CI: 0.59-1.12) and albuminuria.
MAFLD was independently associated with an increased risk of CKD, as well as increased eGFR and UACR. This association is strongly driven by T2DM status. Glycemic deterioration in MAFLD was dose-dependently associated with an increased risk of CKD. Achieved metabolic goals in MAFLD decreased the risk of CKD by reducing the risk of albuminuria.
尽管 2 型糖尿病（T2DM）在代谢功能相关脂肪性肝病（MAFLD）与慢性肾脏病（CKD）之间的关联中起着重要作用，但 T2DM 的发展和血糖恶化如何影响 CKD 及其肾功能指标，估算肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（UACR），仍不清楚。我们旨在评估 MAFLD 与 T2DM 与 CKD 风险之间的关联，然后评估 MAFLD 中代谢目标的实现对 CKD 风险的影响。
在这项横断面研究中，纳入了 5594 名参与者。采用多变量 logistic 回归和线性回归来检验 MAFLD 及其 T2DM 状态和代谢目标的实现与 CKD 风险以及 eGFR 和 UACR 之间的关系。
MAFLD 组 CKD 的患病率（16.2%比 7.6%，<0.001）高于非 MAFLD 组。MAFLD 与 CKD 风险增加独立相关（比值比[OR]：1.35，95%置信区间[CI]：1.09-1.67），并与 eGFR 和 UACR 增加相关。在 MAFLD 的三种亚型中，只有 T2DM 亚型与 CKD 风险增加显著相关（OR：2.85，95%CI：2.24-3.63），同时 eGFR 和 UACR 也增加。MAFLD 中的血糖恶化与 CKD 风险增加呈剂量依赖性相关（-趋势<0.001）。MAFLD 中实现代谢目标降低了 CKD、eGFR 和 UACR 的风险；MAFLD 有 2 个或 3 个代谢目标实现与 CKD 风险（OR：0.81，95%CI：0.59-1.12）和白蛋白尿无关。
MAFLD 与 CKD 风险增加以及 eGFR 和 UACR 增加独立相关。这种关联主要由 T2DM 状态驱动。MAFLD 中的血糖恶化与 CKD 风险增加呈剂量依赖性相关。MAFLD 中代谢目标的实现通过降低白蛋白尿风险降低了 CKD 的风险。
