NAFLD: comorbid CKD tied to greater odds of early death

  • Paik J & al.
  • Liver Int
  • 22 Oct 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Moderate to advanced-stage chronic kidney disease (CKD) is an independent predictor of early death among patients with nonalcoholic fatty liver disease (NAFLD).

Why this matters

  • This population study clearly links NAFLD and CKD; patients at risk for adverse outcomes should be identified and managed appropriately.

Study design

  • Study of 11,695 individuals (mean age, 43.3 years; 48.4% male; 76.4% white) in NHANES-III (1988-1994) with linked mortality data.
  • 6.8% had CKD, 16.1% had NAFLD, 2.5% had NAFLD+CKD, and 74.6% had neither condition.
  • Funding: None.     

Key results

  • Individuals with NAFLD+CKD were more likely to be older, have less income, and have additional comorbidities (all P<.05 than those with neither condition.>
  • Age-adjusted CKD prevalence in NAFLD was 11.31%; most cases were stage I (6.1%), II (3.7%), or IIIa (2.8%).
  • Overall and cardiovascular disease (CVD) mortality rates in NAFLD+CKD were 54.69% and 16.03%, respectively, over a mean of 19.2 years.
  • In multivariate analysis, risk for overall death was higher in NAFLD+CKD (aHR=2.34; P<.05 than ckd alone p vs neither.>
  • In NAFLD, mortality risk increased by CKD stage:
    • Overall mortality: stages II-IIIa (aHR=2.31; P<.0001 vs iiib-v p>
    • CVD mortality: stages II-IIIa (aHR=2.06; P=.0150) vs IIIb-V (aHR=6.04; P=.0003).

Limitations

  • NAFLD prevalence potentially underestimated.
  • Cross-sectional analysis.

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