Abstract

BACKGROUND: As the prevalence of non-alcoholic fatty liver disease (NAFLD) escalates, understanding its potential impact on the development of chronic kidney disease (CKD) is needed.OBJECTIVE: To determine the longitudinal association of NAFLD with the development of advanced CKD in the United States.METHODS: A retrospective cohort analysis of the Truven Health MarketScan Database (2006-2015) was conducted. We used Cox proportional hazards models to compare the risk of developing CKD stages 3-5 in NAFLD versus non-NAFLD patients, identified by ICD-9 codes, after 1:3 propensity score (PS) matching.RESULTS: In a cohort of 262,619 newly diagnosed NAFLD patients and 769,878 PS (1:3) - matched non-NAFLD patients, we identified 5766 and 8655 new advanced (stage 3-5) CKD cases, respectively. The crude CKD incidence rate was 8.2 and 5.5 per 1,000 person-years in NAFLD and non-NAFLD groups, respectively. In multivariable Cox model, NAFLD patients had a 41% increased risk of developing advanced CKD compared to non-NAFLD patients [adjusted hazard ratio (aHR), 1.41; 95% confidence interval (CI), 1.36-1.46]. In the sensitivity analysis adjusting for time-varying covariates after NAFLD diagnosis, NAFLD persisted as a significant CKD risk factor (aHR, 1.58; 95% CI, 1.52-1.66) and the association remained significant when stratified by age, gender, and pre-existing comorbidities. The risk of CKD increased in NAFLD with compensated cirrhosis (aHR, 1.47; 95% CI, 1.36-1.59) and decompensated cirrhosis (aHR, 2.28; 95% CI, 2.12-2.46).CONCLUSION: NAFLD was independently associated with an increased risk of advanced CKD development suggesting renal function screening and regular monitoring are needed in this population. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/joim.12964

View details for PubMedID 31359543