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Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease

Authors
 Da Hea Seo  ;  Young Ju Suh  ;  Yongin Cho  ;  Seong Hee Ahn  ;  Seongha Seo  ;  Seongbin Hong  ;  Yong-Ho Lee  ;  Young Ju Choi  ;  Eunjig Lee  ;  So Hun Kim 
Citation
 DIABETES & METABOLISM JOURNAL, Vol.46(4) : 630-639, 2022-07 
Journal Title
DIABETES & METABOLISM JOURNAL
ISSN
 2233-6079 
Issue Date
2022-07
MeSH
Diabetes Mellitus, Type 2* / complications ; Diabetes Mellitus, Type 2* / epidemiology ; Humans ; Liver Cirrhosis / complications ; Liver Cirrhosis / epidemiology ; Longitudinal Studies ; Non-alcoholic Fatty Liver Disease* / complications ; Non-alcoholic Fatty Liver Disease* / epidemiology ; Renal Insufficiency, Chronic* / complications ; Renal Insufficiency, Chronic* / epidemiology
Keywords
Diabetes mellitus, type 2 ; Fibrosis ; Liver ; Non-alcoholic fatty liver disease ; Renal insufficiency, chronic
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). However, the causal relationship between NAFLD and CKD is uncertain, particularly in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the association between the presence and severity of NAFLD and incident CKD in patients with T2DM.

Methods: In this longitudinal cohort study of patients with T2DM, 3,188 patients with preserved renal function were followed up for the occurrence of incident CKD. NAFLD was defined as the presence of hepatic steatosis on ultrasonography, without any other causes of chronic liver disease. Advanced liver fibrosis of NAFLD was defined as a fibrosis-4 index ≥2.67. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2.

Results: At baseline, 1,729 (54.2%) patients had NAFLD, of whom 94 (5.4%) had advanced liver fibrosis. During the follow-up of 8.3±3.6 years, 472 (14.8%) patients developed incident CKD: 220 (15.1%) in the non-NAFLD group, 231 (14.1%) in the NAFLD without advanced fibrosis group and 28 (31.1%) in the NAFLD with advanced fibrosis group. There was no increased risk of incident CKD in the NAFLD group compared to the non-NAFLD group (P=0.435). However, among patients with NAFLD, advanced liver fibrosis was associated with an increased risk of CKD (adjusted hazard ratio, 1.75; 95% confidence interval, 1.15 to 2.66; P=0.009).

Conclusion: Advanced liver fibrosis in patients with NAFLD is independently associated with an increased risk of incident CKD in patients with T2DM.
Files in This Item:
T202204545.pdf Download
DOI
10.4093/dmj.2021.0130
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Yong Ho(이용호) ORCID logo https://orcid.org/0000-0002-6219-4942
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191616
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