Heo Ji Hye, Lee Mi Yeon, Kim Seong Hwan, Zheng Ming-Hua, Byrne Christopher D, Targher Giovanni, Sung Ki-Chul
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Hepatobiliary Surg Nutr. 2024 Oct 1;13(5):801-813. doi: 10.21037/hbsn-23-558. Epub 2024 Jun 14.
We examined the comparative associations between non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) definitions with risk of developing chronic kidney disease (CKD) and abnormal albuminuria.
We conducted a cohort study of 214,145 Korean adults with normal kidney function at baseline who underwent liver ultrasonography. Participants were further subdivided into no steatotic liver disease (no-SLD), NAFLD-only, MASLD-only, both NAFLD and MASLD, and SLD not categorized as NAFLD or MASLD groups. Cox proportional hazards models were used to analyze the risk of incident CKD and albuminuria.
Compared with either the no-NAFLD or no-MASLD groups, the NAFLD and MASLD groups were associated with a higher risk of incident CKD (NAFLD: adjusted hazard ratio (HR), 1.18 [95% CI, 1.01-1.38]; MASLD: adjusted HR, 1.21 [95% CI, 1.04-1.39]). Among the five subgroups, both NAFLD and MASLD group had the strongest association with risk of incident CKD (adjusted HR, 1.21 [95% CI, 1.04-1.42]). The MASLD-only group had the strongest association with incident abnormal albuminuria, with an adjusted HR comparable to that of the both NAFLD and MASLD group (adjusted HR 1.96 [95% CI, 1.44-2.67] for the MASLD-only, and adjusted HR 1.98 [95% CI, 1.58-2.49] for the both NAFLD and MASLD group versus the no-SLD group). The NAFLD-only group was not independently associated with risk of CKD or abnormal albuminuria.
These findings suggest that MASLD definition identifies individuals at high risk of developing incident CKD or abnormal albuminuria better than NAFLD definition.
我们研究了非酒精性脂肪性肝病（NAFLD）和代谢功能障碍相关脂肪性肝病（MASLD）定义与慢性肾脏病（CKD）发生风险及白蛋白尿异常之间的比较关联。
我们对214,145名基线时肾功能正常且接受肝脏超声检查的韩国成年人进行了一项队列研究。参与者进一步细分为无脂肪性肝病（无-SLD）、仅NAFLD、仅MASLD、NAFLD和MASLD均有以及未归类为NAFLD或MASLD的SLD组。采用Cox比例风险模型分析CKD和白蛋白尿的发病风险。
与无NAFLD或无MASLD组相比，NAFLD组和MASLD组发生CKD的风险更高（NAFLD：调整后风险比（HR），1.18[95%置信区间（CI），1.01 - 1.38]；MASLD：调整后HR，1.21[95%CI，1.04 - 1.39]）。在五个亚组中，NAFLD和MASLD均有的组与CKD发生风险的关联最强（调整后HR，1.21[95%CI，1.04 - 1.42]）。仅MASLD组与白蛋白尿异常的发生关联最强，调整后HR与NAFLD和MASLD均有的组相当（仅MASLD组调整后HR 1.96[95%CI，1.44 - 2.67]，NAFLD和MASLD均有的组与无-SLD组相比调整后HR 1.98[95%CI，1.58 - 2.49]）。仅NAFLD组与CKD或白蛋白尿异常的风险无独立关联。
这些发现表明，MASLD定义比NAFLD定义能更好地识别发生CKD或白蛋白尿异常的高风险个体。
