Journal Article

The impact of non-alcoholic fatty liver disease and liver fibrosis on adverse clinical outcomes and mortality in patients with chronic kidney disease: a prospective cohort study using the UK Biobank

Hydes, Theresa J., Roderick, Paul, Parkes, Julie, Cuthbertson, Daniel J., Kennedy, Oliver J., Fraser, Simon D. S., Buchanan, Ryan

2023

Overview

Background Chronic kidney disease (CKD) and non-alcoholic fatty liver disease (NAFLD) frequently co-exist. We assess the impact of having NAFLD on adverse clinical outcomes and all-cause mortality for people with CKD. Methods A total of 18,073 UK Biobank participants identified to have CKD (eGFR < 60 ml/min/1.73 m 2 or albuminuria > 3 mg/mmol) were prospectively followed up by electronic linkage to hospital and death records. Cox-regression estimated the hazard ratios (HR) associated with having NAFLD (elevated hepatic steatosis index or ICD-code) and NAFLD fibrosis (elevated fibrosis-4 (FIB-4) score or NAFLD fibrosis score (NFS)) on cardiovascular events (CVE), progression to end-stage renal disease (ESRD) and all-cause mortality. Results 56.2% of individuals with CKD had NAFLD at baseline, and 3.0% and 7.7% had NAFLD fibrosis according to a FIB-4 > 2.67 and NFS ≥ 0.676, respectively. The median follow-up was 13 years. In univariate analysis, NAFLD was associated with an increased risk of CVE (HR 1.49 [1.38–1.60]), all-cause mortality (HR 1.22 [1.14–1.31]) and ESRD (HR 1.26 [1.02–1.54]). Following multivariable adjustment, NAFLD remained an independent risk factor for CVE overall (HR 1.20 [1.11–1.30], p  < 0.0001), but not ACM or ESRD. In univariate analysis, elevated NFS and FIB-4 scores were associated with increased risk of CVE (HR 2.42 [2.09–2.80] and 1.64 [1.30–2.08]) and all-cause mortality (HR 2.82 [2.48–3.21] and 1.82 [1.47–2.24]); the NFS score was also associated with ESRD (HR 5.15 [3.52–7.52]). Following full adjustment, the NFS remained associated with an increased incidence of CVE (HR 1.19 [1.01–1.40]) and all-cause mortality (HR 1.31 [1.13–1.52]). Conclusions In people with CKD, NAFLD is associated with an increased risk of CVE, and the NAFLD fibrosis score is associated with an elevated risk of CVE and worse survival.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Alcohol / Algorithms / Biobanks / Biological Specimen Banks / Biomedicine / Cardiovascular disease / Care and treatment / Chronic kidney disease / Chronic kidney failure / Clinical outcomes / Cohort analysis / Complications and side effects / Creatinine / End-stage renal disease / Fatty liver / Fibrosis / Forecasts and trends / Hospitals / Humans / Kidney diseases / Kidney Failure, Chronic - epidemiology / Kidneys / Liver / Liver Cirrhosis - complications / Liver Cirrhosis - epidemiology / Liver diseases / Medicine / Medicine & Public Health / Metabolism / Mortality / Multi-morbidity / Non-alcoholic fatty liver disease / Non-alcoholic Fatty Liver Disease - complications / Non-alcoholic Fatty Liver Disease - epidemiology / Prevention / Prospective Studies / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - epidemiology / Renal replacement therapy / Research Article / Risk factors / Severity of Illness Index / Steatosis / United Kingdom / United Kingdom - epidemiology / Urine