Prevalence of Non-Alcoholic Fatty Liver Disease in Patients With Chronic Kidney Disease

A Cross-Sectional Study

Therese Adrian; Ida M.H. Sørensen; Filip K. Knop; Susanne Bro; Ellen L.F. Ballegaard; Børge G. Nordestgaard; Andreas Fuchs; Klaus F. Kofoed; Jørgen T. Kühl; Per E. Sigvardsen; Mads Hornum; Bo Feldt-Rasmussen

Disclosures

Nephrol Dial Transplant. 2022;37(10):1927-1934. 

In This Article

Abstract and Introduction

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and represents a wide spectrum ranging from mild steatosis to non-alcoholic steatohepatitis with or without fibrosis to overt cirrhosis. Patients with NAFLD have a high risk of developing cardiovascular disease and chronic kidney disease (CKD). So far there has been scarce evidence of the prevalence of NAFLD among patients with CKD. We investigated the prevalence of moderate–severe hepatic steatosis graded according to the definition of NAFLD in a cohort of patients with CKD.

Methods: Hepatic liver fat content was evaluated by computed tomography (CT) scan in 291 patients from the Copenhagen CKD Cohort Study and in 866 age- and sex-matched individuals with normal kidney function from the Copenhagen General Population Study. Liver attenuation density <48 HU was used as a cut-off value for moderate–severe hepatic steatosis.

Results: The prevalence of moderate–severe hepatic steatosis was 7.9 and 10.7% (P = 0.177) among patients with CKD and controls, respectively. No association between liver fat content and CKD stage was found. In the pooled dataset from both cohorts, adjusted odds ratios for moderate–severe hepatic steatosis among persons with diabetes, overweight and obesity were 3.1 [95% confidence interval (CI) 1.6–5.9], 14.8 (95% CI 4.6–47.9) and 42.0 (95% CI 12.9–136.6), respectively.

Conclusions: In a cohort of 291 patients with CKD, kidney function was not associated with the prevalence of moderate–severe hepatic steatosis as assessed by CT scan.

Introduction

Non-alcoholic fatty liver disease (NAFLD) affects approximately one-quarter of the world's adult population and is associated with increased morbidity and mortality.[1,2] The disease is defined as fat accumulation in >5% of hepatocytes and covers a spectrum of conditions ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) with or without fibrosis to overt cirrhosis.[3,4] The more advanced stages of NAFLD are associated with an increased risk of liver failure, hepatocellular carcinoma and liver-related death.[5,6] NAFLD is often regarded as the hepatic manifestation of metabolic syndrome,[6] and the estimated prevalence of NAFLD in patients with type 2 diabetes ranges from 31 to 72% depending on the geographical region and methodology used to diagnose the condition.[7–10]

In recent years, several studies have shown an association between NAFLD, cardiovascular disease and chronic kidney disease (CKD) independent of type 2 diabetes. Current evidence suggests that the coexistence of NAFLD and CKD [defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or albuminuria] is increasing, particularly in overweight patients, and the presence of both may have additive effects in terms of cardiovascular morbidity and mortality.[11] CKD is a global health problem affecting 11–13% of the general population[12] and up to 25% of individuals >65 years of age.[13] As stated in two recent reviews summarizing the findings of 14 studies,[11,14] the prevalence of CKD among adults with hepatic steatosis ranges from 20 to 55%, compared with 5–30% among those without hepatic steatosis.

Cross-sectional and longitudinal studies have shown that the presence and severity of NAFLD is associated with an increased prevalence of CKD,[11,15–17] but only a few studies have investigated the prevalence of NAFLD in patients with CKD.[18–20]

Here we investigated the prevalence of moderate–severe hepatic steatosis as assessed by computed tomography (CT) scan in a cohort of patients with CKD Stages 1–5 and in individuals in a cohort of the general Danish population with normal kidney function.

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