Introduction
Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of chronic kidney disease (CKD).
Aims & Methods
This study aimed to investigate whether the degree of steatosis and fibrosis is associated with an increased risk of CKD in patients with diabetes mellitus (DM). Between January and August 2023, 324 patients with DM were enrolled in the study, after excluding those with viral hepatitis, cirrhosis, and any cancers. Patients provided written informed consent, underwent several clinical measurements, and provided past medical histories. Body weight (BW), body mass index (BMI), waist circumference (WC), laboratory variables including serum creatinine and estimated glomerular filtration rate {eGFR, 175 × Serum Cr-1.154× age-0.203 × 1.212 (if patient is black) × 0.742 (if female)}, presence of hypertension, and dyslipidemia were investigated. The degree of steatosis was estimated using the fatty liver index {FLI, (e(0.953×ln(triglyceride, TG)+0.139×BMI+0.718×ln(gamma-glutamyltrasnsferase, GGT)+0.053×WC-15.745))/(1+ e(0.953×ln(TG)+0.139×BMI+0.718×ln(GGT)+0.053×WC-15.745))×100}, hepatic steatosis index {HSI, 8x(alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio+BMI (+2, if female; +2, if diabetes mellitus)}, and controlled attenuation parameter (CAP by FibroScan®). The degree of fibrosis was estimated using fibrosis-4 (FIB-4) index, NAFLD fibrosis score (NFS), and liver stiffness (LS by FibroScan®). CKD was defined as eGFR less than 60 mL/min/1.73m2.
Results
The mean age of the patients was 57±12 years, and 54.9% (n=178) were male. The mean CAP and LS values were 276±50 dB/m and 7.0±3.7 kPa, respectively. CAP values were correlated with BW (r=0.524, p<0.001), BMI (r=0.625, p<0.001), WC (r=0.592, p<0.001), FLI (r=0.637, p<0.001), and HSI (r=0.653, p<0.001). LS values were correlated with BW (r=0.364, p<0.001), BMI (r=0.531, p<0.001), WC (r=0.46, p<001), and FIB-4 (r=0.3, p<0.001), but not correlated with NFS. Twenty-nine (8.9%) patients had CKD, of whom 14 were male. Patients with CKD were older (mean age: 63±11 vs. 56±12 years, p=0.005) and had a higher prevalence of hypertension (79.3% vs. 49.8%, p=0.002) compared to those without CKD. AST (29±22 vs. 30±20 IU/L), ALT (36±39 vs. 37±27 IU/L), GGT (40±30 vs. 44±73 IU/L), and HbA1C (7.3±1.3 vs. 7.3±1.4%) were not different between the two groups. The prevalence of dyslipidemia (75.9% vs. 63.4%), BW (73±15 vs. 72±15 kg), BMI (28±4 vs. 27±5 kg/m2), and WC (92±11 vs. 90±11 cm) were also not different between the two groups. CAP value (273±55 vs. 276±50 dB/m), FLI (49±29 vs. 48±29), and HSI (40±7 vs. 39±7) were not different between the two groups. LS value (7.0±2.2 vs. 7.0±3.8 kPa), NFS (-1.0±1.3 vs. -1.2±2.6), and FIB-4 (1.3±0.6 vs. 1.2±0.8) were also not different between the two groups. Multivariate logistic analysis revealed that age [odds ratio (OR): 1.047, 95% confidence interval (CI): 1.008-1.088, p=0.019] and hypertension (OR: 3.260, 95% CI: 1.274-8.339, p<0.014) were the independent risk factors for CKD.
Conclusion
The steatosis estimated by CAP and the fibrosis estimated by LS were not associated with the risk of CKD in patients with DM.
