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Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease.
Nephrol Dial Transplant. 2019 03 01; 34(3):449-457.ND

Abstract

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor associated with cardiovascular disease (CVD) and incidence of chronic kidney disease (CKD). NAFLD is threatening to become a major public health problem in association with the metabolic syndrome. The association of NAFLD with outcomes in patients with advanced CKD has not been evaluated. In this study, the prevalence of NAFLD and its impact on cardiovascular and renal outcomes and mortality were determined in a large secondary care CKD cohort.

METHODS

The study was conducted on 1148 CKD patients within a cohort of 3061 CKD patients, who had undergone ultrasound imaging of the liver over a 15-year period. A propensity-matched population from within the cohort was also included. Cox regression analysis was used to study the association of NAFLD with cardiovascular events, end-stage renal disease and mortality and linear regression analysis for CKD progression.

RESULTS

The prevalence of NAFLD was 17.9%. The median duration of follow-up after scanning was 5.4 years, with a median estimated glomerular filtration rate (eGFR) of 33.5 mL/min/1.73 m2 in this population. NAFLD proved to be a strong independent risk factor for cardiovascular events [hazard ratio (HR) 2.03; 95% confidence interval (CI) 1.33-3.13; P < 0.01] but it was not associated with all-cause mortality (HR 0.79; 95% CI 0.58-1.08; P = 0.14) or CKD progression (P = 0.09 for rate of decline of eGFR slope). Patients with CKD are known to have high cardiovascular risk; the propensity-matched analysis showed that NAFLD increased this cardiovascular risk (HR 2.00; CI 1.10-3.66; P < 0.05).

CONCLUSIONS

NAFLD has a strong independent association with cardiovascular events, even in an advanced CKD cohort with high comorbidity. The implication is that routine screening for NAFLD may be warranted in CKD populations to enable targeted interventions for CVD prevention in higher risk patients.

Authors+Show Affiliations

Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29390103

Citation

Chinnadurai, Rajkumar, et al. "Non-alcoholic Fatty Liver Disease and Clinical Outcomes in Chronic Kidney Disease." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 34, no. 3, 2019, pp. 449-457.
Chinnadurai R, Ritchie J, Green D, et al. Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease. Nephrol Dial Transplant. 2019;34(3):449-457.
Chinnadurai, R., Ritchie, J., Green, D., & Kalra, P. A. (2019). Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 34(3), 449-457. https://doi.org/10.1093/ndt/gfx381
Chinnadurai R, et al. Non-alcoholic Fatty Liver Disease and Clinical Outcomes in Chronic Kidney Disease. Nephrol Dial Transplant. 2019 03 1;34(3):449-457. PubMed PMID: 29390103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease. AU - Chinnadurai,Rajkumar, AU - Ritchie,James, AU - Green,Darren, AU - Kalra,Philip A, PY - 2017/09/30/received PY - 2017/12/19/accepted PY - 2018/2/2/pubmed PY - 2019/12/28/medline PY - 2018/2/2/entrez KW - all-cause mortality KW - cardiovascular disease KW - chronic kidney disease KW - non-alcoholic fatty liver disease KW - prevalence SP - 449 EP - 457 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 34 IS - 3 N2 - BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor associated with cardiovascular disease (CVD) and incidence of chronic kidney disease (CKD). NAFLD is threatening to become a major public health problem in association with the metabolic syndrome. The association of NAFLD with outcomes in patients with advanced CKD has not been evaluated. In this study, the prevalence of NAFLD and its impact on cardiovascular and renal outcomes and mortality were determined in a large secondary care CKD cohort. METHODS: The study was conducted on 1148 CKD patients within a cohort of 3061 CKD patients, who had undergone ultrasound imaging of the liver over a 15-year period. A propensity-matched population from within the cohort was also included. Cox regression analysis was used to study the association of NAFLD with cardiovascular events, end-stage renal disease and mortality and linear regression analysis for CKD progression. RESULTS: The prevalence of NAFLD was 17.9%. The median duration of follow-up after scanning was 5.4 years, with a median estimated glomerular filtration rate (eGFR) of 33.5 mL/min/1.73 m2 in this population. NAFLD proved to be a strong independent risk factor for cardiovascular events [hazard ratio (HR) 2.03; 95% confidence interval (CI) 1.33-3.13; P < 0.01] but it was not associated with all-cause mortality (HR 0.79; 95% CI 0.58-1.08; P = 0.14) or CKD progression (P = 0.09 for rate of decline of eGFR slope). Patients with CKD are known to have high cardiovascular risk; the propensity-matched analysis showed that NAFLD increased this cardiovascular risk (HR 2.00; CI 1.10-3.66; P < 0.05). CONCLUSIONS: NAFLD has a strong independent association with cardiovascular events, even in an advanced CKD cohort with high comorbidity. The implication is that routine screening for NAFLD may be warranted in CKD populations to enable targeted interventions for CVD prevention in higher risk patients. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/29390103/Non_alcoholic_fatty_liver_disease_and_clinical_outcomes_in_chronic_kidney_disease_ DB - PRIME DP - Unbound Medicine ER -