Yang Tianyuan, Yang Bingqing, Yin Jingya, Hou Chenxue, Wang Qi
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
Biomedicines. 2025 Apr 1;13(4):842. doi: 10.3390/biomedicines13040842.
Chronic kidney disease (CKD) is a recognized extra-hepatic disease of nonalcoholic fatty liver disease (NAFLD). With the redefinition of NAFLD as metabolic dysfunction-associated steatotic liver disease (MASLD), the importance of cardiovascular metabolic factors in MASLD has been highlighted. However, whether MASLD remains independently associated with the prevalence of CKD is yet to be determined. We analyzed data from 6567 non-pregnant adults from the National Health and Nutrition Examination Survey 2017-2020. MASLD was identified using liver ultrasound transient elastography and five cardiovascular risk factors. Multivariate logistic regression, subgroup analysis, and restricted cubic splines were employed to explore the associations and interactions within the data. The prevalence of CKD across MASLD subgroups with different combinations of cardiometabolic risk factors varied. Univariate regression analysis indicated a significant association between MASLD and CKD (OR: 1.68, < 0.001). This association was not significant after adjusting for diabetes (OR: 0.94, = 0.74) or insulin resistance (OR: 1.00, = 0.98) and was not significant in the fully adjusted model (OR: 0.87, = 0.64). Subgroup analysis confirmed insulin resistance as a modifier in the MASLD-CKD relationship ( for interaction = 0.02). Multivariate analysis revealed that liver stiffness measurements (LSMs) were independently associated with CKD. LSM values showed an S-shaped correlation with CKD, with risk increasing above the 8.612 kPa threshold. This study suggests that the direct relationship between MASLD and CKD diminished when accounting for insulin resistance. Nevertheless, liver fibrosis emerges as an independent CKD risk factor, emphasizing the critical need for targeted CKD screening among MASLD patients, particularly those with insulin resistance or advanced fibrosis.
慢性肾脏病（CKD）是一种公认的非酒精性脂肪性肝病（NAFLD）的肝外疾病。随着NAFLD重新定义为代谢功能障碍相关脂肪性肝病（MASLD），心血管代谢因素在MASLD中的重要性得到了凸显。然而，MASLD是否仍然与CKD的患病率独立相关尚待确定。我们分析了来自2017 - 2020年国家健康与营养检查调查的6567名非妊娠成年人的数据。使用肝脏超声瞬时弹性成像和五个心血管危险因素来识别MASLD。采用多变量逻辑回归、亚组分析和受限立方样条来探索数据中的关联和相互作用。不同心脏代谢危险因素组合的MASLD亚组中CKD的患病率各不相同。单变量回归分析表明MASLD与CKD之间存在显著关联（比值比：1.68，P < 0.001）。在调整糖尿病（比值比：0.94，P = 0.74）或胰岛素抵抗（比值比：1.00，P = 0.98）后，这种关联不显著，在完全调整模型中也不显著（比值比：0.87，P = 0.64）。亚组分析证实胰岛素抵抗是MASLD与CKD关系中的一个调节因素（交互作用P = 0.02）。多变量分析显示肝脏硬度测量值（LSMs）与CKD独立相关。LSM值与CKD呈S形相关性，在8.612 kPa阈值以上风险增加。这项研究表明，在考虑胰岛素抵抗时，MASLD与CKD之间的直接关系减弱。然而，肝纤维化成为一个独立的CKD危险因素，强调了对MASLD患者，特别是那些有胰岛素抵抗或晚期纤维化患者进行针对性CKD筛查的迫切需要。
