![]() Two papers examined CKD progression in one, the adjusted rate of decline in estimated glomerular filtration rate (eGFR) per year was higher in those with NAFLD, whereas the other found no significant difference. The third study observed NAFLD to be an independent risk factor for non-fatal CVE. The first reported a positive association of NAFLD with all-cause mortality (ACM) however, significance was lost following adjustment for metabolic risk the second study reported no effect on mortality in unadjusted or adjusted models. Only three studies were included, which were diverse in design with conflicting results. We performed a systematic review examining the impact of NAFLD on clinical outcomes and mortality for people with CKD. The implications of having both NAFLD and CKD are poorly understood. As with NAFLD, the leading cause of death for patients with CKD is CVD. CKD is itself an accelerator of CVD risk and an independent risk factor for cardiovascular events (CVEs). The global prevalence of CKD stages 3–5 is approximately 11%, with the prevalence increasing by nearly a third since 2007. ESRD is estimated to be associated with a mean annual health care cost of $20–100,000 per patient in developed countries. It carries a huge burden in terms of health care costs largely due to renal replacement therapy. NASH or hepatic fibrosis.ĬKD is associated with reduced quality of life and increased risk of end-stage renal disease (ESRD), CVD and premature death. In addition, NAFLD is independently associated with an increased risk of chronic kidney disease (CKD) this risk is particularly high where individuals have more advanced liver disease, i.e. Indeed, CVD is the leading cause of mortality relating to NAFLD. NAFLD is also an independent risk factor for cardiovascular disease (CVD) and death. It can progress to non-alcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis and hepatocellular carcinoma. ![]() Non-alcoholic fatty liver disease (NAFLD) refers to the accumulation of excess fat in the liver and affects 25% of adults. In people with CKD, NAFLD is associated with an increased risk of CVE, and the NAFLD fibrosis score is associated with an elevated risk of CVE and worse survival. Following full adjustment, the NFS remained associated with an increased incidence of CVE (HR 1.19 ) and all-cause mortality (HR 1.31 ). In univariate analysis, elevated NFS and FIB-4 scores were associated with increased risk of CVE (HR 2.42 and 1.64 ) and all-cause mortality (HR 2.82 and 1.82 ) the NFS score was also associated with ESRD (HR 5.15 ). Following multivariable adjustment, NAFLD remained an independent risk factor for CVE overall (HR 1.20, p < 0.0001), but not ACM or ESRD. In univariate analysis, NAFLD was associated with an increased risk of CVE (HR 1.49 ), all-cause mortality (HR 1.22 ) and ESRD (HR 1.26 ). Resultsĥ6.2% of individuals with CKD had NAFLD at baseline, and 3.0% and 7.7% had NAFLD fibrosis according to a FIB-4 > 2.67 and NFS ≥ 0.676, respectively. Cox-regression estimated the hazard ratios (HR) associated with having NAFLD (elevated hepatic steatosis index or ICD-code) and NAFLD fibrosis (elevated fibrosis-4 (FIB-4) score or NAFLD fibrosis score (NFS)) on cardiovascular events (CVE), progression to end-stage renal disease (ESRD) and all-cause mortality. MethodsĪ total of 18,073 UK Biobank participants identified to have CKD (eGFR 3 mg/mmol) were prospectively followed up by electronic linkage to hospital and death records. We assess the impact of having NAFLD on adverse clinical outcomes and all-cause mortality for people with CKD. ![]() Chronic kidney disease (CKD) and non-alcoholic fatty liver disease (NAFLD) frequently co-exist.
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