Risk Stratification of Chronic Kidney Disease in Adults Using Noninvasive Fibrosis Tests Based on the American Diabetes Association Algorithm

Abstract

Aims: Although the American Diabetes Association (ADA) recently established a diagnostic algorithm for the early detection of liver fibrosis among high-risk individuals, its implications for chronic kidney disease (CKD) risk stratification remain unclear. We investigated whether the ADA diagnostic algorithm can effectively stratify CKD risk in individuals at risk of cirrhosis. Materials and Methods: This retrospective cohort study included 9264 adults without pre-existing CKD who underwent vibration-controlled transient elastography from April 2006 to October 2018. Participants were categorized into three groups: (1) no metabolic criteria; (2) low-risk (FIB-4 < 1.3 or 1.3-2.67 with liver stiffness [LS] < 8 kPa) and (3) high risk (FIB-4 > 2.67, or 1.3-2.67 with LS >= 8 kPa). The primary outcome was incident CKD, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/ min/1.73 m(2) or proteinuria (>= 1+) on two consecutive tests. Secondary outcomes included >= 25% eGFR decline on two visits and 3-and 5-year risk of CKD. Results: During a mean follow-up of 3.7 years, 440 (4.7%) participants developed incident CKD. When stratified by the ADA algorithm, multivariable Cox models revealed a 1.52-fold (95% confidence interval [CI], 1.09-2.13) higher risk of incident CKD in the high-risk group than those with no metabolic abnormalities. The high-risk group also had a 2.30-fold higher risk (95% CI, 1.83-2.90) of a 25% eGFR decline (mean follow-up 3.5years) than those with no metabolic abnormalities. Conclusions: The two-step ADA algorithm can effectively stratify CKD risk in individuals at high risk of future cirrhosis.