Kim Dong Wook, Son Minkook, Lee Hye Jung, Choi Chi Hyeon, Kang Yeo Wool, Moon Sang Yi, Koh Myeongseok, Lee Jong Yoon, Baek Yang Hyun, An Won Suk
Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
Department of Physiology, Dong-A University College of Medicine, Busan, South Korea.
Hepatol Res. 2025 Sep;55(9):1239-1250. doi: 10.1111/hepr.14226. Epub 2025 Jun 16.
The shift in terminology from nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD) highlights its association with metabolic dysfunction. MASLD is defined by hepatic steatosis and at least one cardiometabolic risk factor (CMRF), which contribute to chronic kidney disease (CKD). This study examines the relationship between MASLD and CKD, the independent impact of CMRFs on CKD risk, and the cumulative effect of multiple CMRFs on CKD development.
The present retrospective cohort study utilized data from the Korean National Health Insurance System (NHIS), analyzing 211,992 individuals aged ≥ 40 years who underwent health screenings between 2009 and 2010. The average observation period was 9.1 years. Participants were classified into groups: no steatotic liver disease (SLD) without CMRF, no SLD with CMRF, MASLD, and metabolic dysfunction-associated steatotic liver disease with increased alcohol intake (MetALD).
Compared to the no SLD without CMRF group, the adjusted hazard ratios (HRs) for CKD were 1.27 (95% CI: 1.18-1.37) for no SLD with CMRF, 1.70 (95% CI: 1.58-1.83) for MASLD, and 1.47 (95% CI: 1.33-1.63) for MetALD. CKD risk increased with the number of CMRFs, with adjusted HRs increasing from 1.12 (one CMRF) to 1.97 (four CMRFs).
MASLD is independently associated with increased CKD risk. Each CMRF independently contributes to CKD development, and the cumulative effect of multiple CMRFs further amplifies this. This suggests that MASLD is an effective predictor of CKD risk. Given the rising burden of MASLD and its complications, early identification and management of risk factors are crucial for reducing CKD incidence.
术语从非酒精性脂肪性肝病（NAFLD）转变为代谢功能障碍相关脂肪性肝病（MASLD），突出了其与代谢功能障碍的关联。MASLD由肝脂肪变性和至少一种心脏代谢危险因素（CMRF）定义，这些因素会导致慢性肾脏病（CKD）。本研究探讨了MASLD与CKD之间的关系、CMRFs对CKD风险的独立影响以及多种CMRFs对CKD发展的累积效应。
本回顾性队列研究利用了韩国国民健康保险系统（NHIS）的数据，分析了2009年至2010年间接受健康筛查的211,992名年龄≥40岁的个体。平均观察期为9.1年。参与者被分为以下几组：无CMRF的非脂肪性肝病（SLD）、有CMRF的非SLD、MASLD以及酒精摄入量增加的代谢功能障碍相关脂肪性肝病（MetALD）。
与无CMRF的非SLD组相比，有CMRF的非SLD组CKD的校正风险比（HRs）为1.27（95%CI：1.18 - 1.37），MASLD组为1.70（95%CI：1.58 - 1.83），MetALD组为1.47（95%CI：1.33 - 1.63）。CKD风险随着CMRFs数量的增加而增加，校正后的HRs从1.12（一个CMRF）增加到1.97（四个CMRF）。
MASLD与CKD风险增加独立相关。每个CMRF都独立地促进CKD的发展，多种CMRFs的累积效应进一步放大了这种情况。这表明MASLD是CKD风险的有效预测指标。鉴于MASLD及其并发症的负担不断增加，早期识别和管理危险因素对于降低CKD发病率至关重要。
