Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Pediatr Gastroenterol Nutr. 2024 Aug;79(2):238-249. doi: 10.1002/jpn3.12272. Epub 2024 Jun 3.
Renal impairment is prevalent in adults with nonalcoholic fatty liver disease (NAFLD/metabolic dysfunction associated steatotic liver disease [MASLD]) and is associated with increased mortality. Pediatric data are limited. Our objective was to determine the prevalence of hyperfiltration or chronic kidney disease (CKD) in children with NAFLD/MASLD and determine links with liver disease severity.
Data from children who had previously participated in prospective, multicenter, pediatric studies by the Nonalcoholic Steatohepatitis Clinical Research Network (NASH-CRN) were collected. Renal function was determined using the calculated glomerular filtration rate (cGFR). Hyperfiltration was defined as cGFR > 135 mL/min/1.73m, while CKD stage 2 or higher as cGFR < 90 mL/min/1.73 m. Renal dysfunction progression was defined as transition from normal to hyperfiltration or to CKD stage ≥ 2, or change in CKD by ≥1 stage. Multinomial logistic regression models were used to determine the prevalence of CKD and independent associations between CKD and liver disease severity.
The study included 1164 children (age 13 ± 3 years, 72% male, 71% Hispanic). The median cGFR was 121 mL/min/1.73 m; 12% had CKD stage 2-5, while 27% had hyperfiltration. Hyperfiltration was independently associated with significant liver fibrosis (odds ratio: 1.45). Baseline renal function was not associated with progression in liver disease over a 2-year period (n = 145). Renal dysfunction worsened in 19% independently of other clinical risk factors. Progression of renal impairment was not associated with change in liver disease severity.
Renal impairment is prevalent in children with NAFLD/MASLD and hyperfiltration is independently associated with significant liver fibrosis. Almost 1/5 children have evidence of progression in renal dysfunction over 2 years, not associated with change in liver disease severity. Future assessments including additional renal impairment biomarkers are needed.
非酒精性脂肪性肝病（NAFLD/代谢相关脂肪性肝病 [MASLD]）患者普遍存在肾功能损害，并且与死亡率增加相关。儿科数据有限。我们的目的是确定患有 NAFLD/MASLD 的儿童中存在高滤过或慢性肾脏病（CKD）的患病率，并确定其与肝病严重程度的关系。
收集了先前参加过非酒精性脂肪性肝炎临床研究网络（NASH-CRN）前瞻性、多中心儿科研究的儿童的数据。使用计算肾小球滤过率（cGFR）来确定肾功能。高滤过定义为 cGFR＞135 mL/min/1.73m，而 CKD 分期 2 期或更高为 cGFR＜90 mL/min/1.73m。肾功能障碍进展定义为从正常转变为高滤过或 CKD 分期≥2，或 CKD 分期变化≥1 期。使用多项逻辑回归模型来确定 CKD 的患病率以及 CKD 与肝病严重程度之间的独立关联。
该研究纳入了 1164 名儿童（年龄 13±3 岁，72%为男性，71%为西班牙裔）。中位 cGFR 为 121 mL/min/1.73m；12%患有 CKD 分期 2-5 期，27%患有高滤过。高滤过与显著的肝纤维化独立相关（比值比：1.45）。基线肾功能与 2 年内肝病进展无关（n=145）。在没有其他临床危险因素的情况下，19%的儿童肾功能恶化。肾功能损害的进展与肝病严重程度的变化无关。
患有 NAFLD/MASLD 的儿童中肾功能损害普遍存在，高滤过与显著的肝纤维化独立相关。近 1/5 的儿童在 2 年内出现肾功能障碍进展，与肝病严重程度变化无关。需要进一步评估包括其他肾功能损害生物标志物。
