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Nonalcoholic fatty liver disease is independently associated with an increased incidence of chronic kidney disease in patients with type 1 diabetes.
Diabetes Care. 2014 Jun; 37(6):1729-36.DC

Abstract

OBJECTIVE

There is no information about the role of nonalcoholic fatty liver disease (NAFLD) in predicting the development of chronic kidney disease (CKD) in type 1 diabetes.

RESEARCH DESIGN AND METHODS

We studied 261 type 1 diabetic adults with preserved kidney function and with no macroalbuminuria at baseline, who were followed for a mean period of 5.2 years for the occurrence of incident CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 and/or macroalbuminuria). NAFLD was diagnosed by ultrasonography.

RESULTS

At baseline, patients had a mean eGFR of 92 ± 23 mL/min/1.73 m2; 234 (89.7%) of them had normoalbuminuria and 27 (10.3%) microalbuminuria. NAFLD was present in 131 (50.2%) patients. During follow-up, 61 subjects developed incident CKD. NAFLD was associated with an increased risk of incident CKD (hazard ratio [HR] 2.85 [95% CI 1.59-5.10]; P < 0.001). Adjustments for age, sex, duration of diabetes, hypertension, A1C, and baseline eGFR did not appreciably attenuate this association (adjusted HR 2.03 [1.10-3.77], P < 0.01). Results remained unchanged after excluding those who had microalbuminuria at baseline (adjusted HR 1.85 [1.03-3.27]; P < 0.05). Addition of NAFLD to traditional risk factors for CKD significantly improved the discriminatory capability of the regression models for predicting CKD (e.g., with NAFLD c statistic 0.79 [95% CI 0.73-0.86] vs. 0.76 [0.71-0.84] without NAFLD, P = 0.002).

CONCLUSIONS

This is the first study to demonstrate that NAFLD is strongly associated with an increased incidence of CKD. Measurement of NAFLD improves risk prediction for CKD, independently of traditional cardio-renal risk factors, in patients with type 1 diabetes.

Authors+Show Affiliations

Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy giovanni.targher@univr.it.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Department of Public Health and Community Medicine, University of Verona, Verona, ItalyDepartment of Prevention, Public Health Trust, Trento, Italy.Department of Public Health and Community Medicine, University of Verona, Verona, ItalyDepartment of Prevention, Public Health Trust, Trento, Italy.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO.Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, U.K.Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24696459

Citation

Targher, Giovanni, et al. "Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Chronic Kidney Disease in Patients With Type 1 Diabetes." Diabetes Care, vol. 37, no. 6, 2014, pp. 1729-36.
Targher G, Mantovani A, Pichiri I, et al. Nonalcoholic fatty liver disease is independently associated with an increased incidence of chronic kidney disease in patients with type 1 diabetes. Diabetes Care. 2014;37(6):1729-36.
Targher, G., Mantovani, A., Pichiri, I., Mingolla, L., Cavalieri, V., Mantovani, W., Pancheri, S., Trombetta, M., Zoppini, G., Chonchol, M., Byrne, C. D., & Bonora, E. (2014). Nonalcoholic fatty liver disease is independently associated with an increased incidence of chronic kidney disease in patients with type 1 diabetes. Diabetes Care, 37(6), 1729-36. https://doi.org/10.2337/dc13-2704
Targher G, et al. Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Chronic Kidney Disease in Patients With Type 1 Diabetes. Diabetes Care. 2014;37(6):1729-36. PubMed PMID: 24696459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonalcoholic fatty liver disease is independently associated with an increased incidence of chronic kidney disease in patients with type 1 diabetes. AU - Targher,Giovanni, AU - Mantovani,Alessandro, AU - Pichiri,Isabella, AU - Mingolla,Lucia, AU - Cavalieri,Valentina, AU - Mantovani,William, AU - Pancheri,Serena, AU - Trombetta,Maddalena, AU - Zoppini,Giacomo, AU - Chonchol,Michel, AU - Byrne,Christopher D, AU - Bonora,Enzo, Y1 - 2014/04/02/ PY - 2014/4/4/entrez PY - 2014/4/4/pubmed PY - 2014/12/17/medline SP - 1729 EP - 36 JF - Diabetes care JO - Diabetes Care VL - 37 IS - 6 N2 - OBJECTIVE: There is no information about the role of nonalcoholic fatty liver disease (NAFLD) in predicting the development of chronic kidney disease (CKD) in type 1 diabetes. RESEARCH DESIGN AND METHODS: We studied 261 type 1 diabetic adults with preserved kidney function and with no macroalbuminuria at baseline, who were followed for a mean period of 5.2 years for the occurrence of incident CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 and/or macroalbuminuria). NAFLD was diagnosed by ultrasonography. RESULTS: At baseline, patients had a mean eGFR of 92 ± 23 mL/min/1.73 m2; 234 (89.7%) of them had normoalbuminuria and 27 (10.3%) microalbuminuria. NAFLD was present in 131 (50.2%) patients. During follow-up, 61 subjects developed incident CKD. NAFLD was associated with an increased risk of incident CKD (hazard ratio [HR] 2.85 [95% CI 1.59-5.10]; P < 0.001). Adjustments for age, sex, duration of diabetes, hypertension, A1C, and baseline eGFR did not appreciably attenuate this association (adjusted HR 2.03 [1.10-3.77], P < 0.01). Results remained unchanged after excluding those who had microalbuminuria at baseline (adjusted HR 1.85 [1.03-3.27]; P < 0.05). Addition of NAFLD to traditional risk factors for CKD significantly improved the discriminatory capability of the regression models for predicting CKD (e.g., with NAFLD c statistic 0.79 [95% CI 0.73-0.86] vs. 0.76 [0.71-0.84] without NAFLD, P = 0.002). CONCLUSIONS: This is the first study to demonstrate that NAFLD is strongly associated with an increased incidence of CKD. Measurement of NAFLD improves risk prediction for CKD, independently of traditional cardio-renal risk factors, in patients with type 1 diabetes. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/24696459/Nonalcoholic_fatty_liver_disease_is_independently_associated_with_an_increased_incidence_of_chronic_kidney_disease_in_patients_with_type_1_diabetes_ DB - PRIME DP - Unbound Medicine ER -