Development of chronic kidney disease in patients with non-alcoholic fatty liver disease: A cohort study

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods: We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9 y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results: The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60 ml/min/1.73 m(2). During 200,790 person-years of follow-up (median follow-up of 4.15 years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04-1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS < - 1.455 and those with NFS >= - 1.455 to participants without NAFLD were 1.09 (95% CI 0.91-1.32) and 1.58 (95% CI 1.30-1.92), respectively. The association was consistent across clinically relevant subgroups. Conclusion: In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.