代谢功能障碍相关脂肪性肝病（SLD）和酒精性肝病，但非无代谢功能障碍的SLD，在10年随访期内与慢性肾脏病的新发独立相关。
Metabolic dysfunction-associated steatotic liver disease (SLD) and alcohol-associated liver disease, but not SLD without metabolic dysfunction, are independently associated with new onset of chronic kidney disease during a 10-year follow-up period.
作者信息
Mori Kazuma, Tanaka Marenao, Sato Tatsuya, Akiyama Yukinori, Endo Keisuke, Ogawa Toshifumi, Suzuki Toru, Aida Hiroki, Kawaharata Wataru, Nakata Kei, Hosaka Itaru, Umetsu Araya, Hanawa Nagisa, Furuhashi Masato
机构信息
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Immunology and Microbiology, National Defense Medical College, Tokorozawa, Japan.
出版信息
Hepatol Res. 2024 Aug 7. doi: 10.1111/hepr.14097.
AIMS
The new nomenclature of steatotic liver disease (SLD) including metabolic dysfunction-associated SLD (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD) has recently been proposed. We aimed to elucidate the relationship between each category of SLD and chronic kidney disease (CKD).
METHODS
We investigated the effects of various SLDs on the development of CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m or positive for urinary protein, during a 10-year period in 12 138 Japanese subjects (men / women, 7984/4154; mean age, 48 years) who received annual health examinations including abdominal ultrasonography.
RESULTS
The prevalences of SLD without metabolic dysfunction (SLD-MD[-]), MASLD, MetALD, and ALD were 1.7%, 26.3%, 4.9%, and 1.9%, respectively. During the follow-up period, 1963 subjects (16.2%) (men / women, 1374 [17.2%]/589 [14.2%]) had new onset of CKD. Multivariable Cox proportional hazard model analyses after adjustment of age, sex, eGFR, current smoking habit, diabetes mellitus, hypertension, and dyslipidemia showed that the hazard ratios (HR [95% confidence interval]) for the development of CKD in subjects with MASLD (1.20 [1.08-1.33], p = 0.001) and those with ALD (1.41 [1.05-1.88], p = 0.022), but not those with MetALD (1.11 [0.90-1.36], p = 0.332), were significantly higher than the HR in subjects with non-SLD. Interestingly, subjects with SLD-MD[-] had a significantly lower HR (0.61 [0.39-0.96], p = 0.034) than that in subjects with non-SLD. The addition of the novel classification of SLDs into traditional risk factors for the development of CKD significantly improved the discriminatory capacity.
CONCLUSIONS
MASLD and ALD, but not SLD-MD[-], are independently associated with the development of CKD.
目的
最近提出了脂肪性肝病（SLD）的新命名法，包括代谢功能障碍相关脂肪性肝病（MASLD）、MASLD与酒精摄入量增加（MetALD）以及酒精性肝病（ALD）。我们旨在阐明各类SLD与慢性肾脏病（CKD）之间的关系。
方法
我们在12138名日本受试者（男性/女性，7984/4154；平均年龄48岁）中，调查了各类SLD对CKD发生发展的影响，CKD定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²或尿蛋白阳性，这些受试者接受了包括腹部超声在内的年度健康检查，随访期为10年。
结果
无代谢功能障碍的脂肪性肝病（SLD-MD[-]）、MASLD、MetALD和ALD的患病率分别为1.7%、26.3%、4.9%和1.9%。在随访期间，有CKD新发的受试者有1963名（占16.2%）（男性/女性，1374名[占17.2%]/589名[占14.2%]）。在对年龄、性别、eGFR、当前吸烟习惯、糖尿病、高血压和血脂异常进行调整后，多变量Cox比例风险模型分析显示，MASLD患者（1.20[1.08 - 1.33]，p = 0.001）和ALD患者（1.41[1.05 - 1.88]，p = 0.022）发生CKD的风险比（HR[95%置信区间]）显著高于非SLD患者，但MetALD患者（1.11[0.90 - 1.36]，p = 0.332）并非如此。有趣的是，SLD-MD[-]患者的HR（0.61[0.39 - 0.96]，p = 0.034）显著低于非SLD患者。将新的SLD分类纳入CKD发生发展的传统风险因素中，显著提高了鉴别能力。
结论
MASLD和ALD与CKD的发生独立相关，而SLD-MD[-]并非如此。
Zotero 插件