New Nonalcoholic Fatty Liver Disease and Fibrosis Progression Associate With the Risk of Incident Chronic Kidney Disease

Context Little is known about the link between nonalcoholic fatty liver disease (NAFLD) evolution and incident chronic kidney disease (CKD). Objective We aim to assess the associations of NALFD status changes and NAFLD fibrosis progression with the risk of incident CKD. Methods We conducted a community-based prospective study including participants aged 40 years or older and free of CKD at baseline in 2010, and followed up after a mean of 4.4 years. NAFLD was diagnosed by ultrasonography. NAFLD fibrosis score (NFS) was used to evaluate fibrosis stage and progression. CKD was defined by estimated glomerular filtration rate (eGFR) or urine albumin-to-creatinine ratio (UACR). All the measurements were performed at baseline and follow-up examination. Results Among 4,042 participants with four NAFLD status change groups, incident NAFLD was associated with an increased risk of incident CKD (Odds Ratio, OR = 1.44, 95% Confidence Interval [CI] 1.003 - 2.06; P = 0.048) compared to non-NAFLD after adjustments for the confounders including evolution of diabetes, hypertension and obesity in addition to the baseline levels. However, the risk of incident CKD was not significantly different between NAFLD resolution and persistent NAFLD. Among 534 participants in persistent NAFLD group, those with fibrosis progression from low NFS to intermediate or high NFS was associated with a significantly increased risk of incident CKD compared to those with fibrosis stable in low NFS (OR = 2.82, 95% CI 1.22 - 6.56; P = 0.016). Conclusions NAFLD development and fibrosis progression are associated with increased risk of incident CKD.