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Increased mortality in non-alcoholic fatty liver disease with chronic kidney disease is explained by metabolic comorbidities

Önnerhag, Kristina LU ; Dreja, Karl LU ; Nilsson, Peter M. LU and Lindgren, Stefan LU (2019) In Clinics and Research in Hepatology and Gastroenterology
Abstract


Background: There is a close association between non-alcoholic fatty liver disease (NAFLD) and prevalent chronic kidney disease (CKD). Few longitudinal studies exist. No previous study has investigated to what extent CKD affects mortality in biopsy-proven NAFLD. Our aim was to investigate the long-term risk of developing CKD in biopsy-proven NAFLD and its effect on mortality. Methods: Patients with biopsy-proven NAFLD diagnosed in 1978-2006 in Malmö, Sweden were included. Estimated glomerular filtration rate (eGFR) at baseline and last follow-up was calculated with the CKD-EPI equation. CKD 3–5 (< 60 mL/min/1.73 m
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Background: There is a close association between non-alcoholic fatty liver disease (NAFLD) and prevalent chronic kidney disease (CKD). Few longitudinal studies exist. No previous study has investigated to what extent CKD affects mortality in biopsy-proven NAFLD. Our aim was to investigate the long-term risk of developing CKD in biopsy-proven NAFLD and its effect on mortality. Methods: Patients with biopsy-proven NAFLD diagnosed in 1978-2006 in Malmö, Sweden were included. Estimated glomerular filtration rate (eGFR) at baseline and last follow-up was calculated with the CKD-EPI equation. CKD 3–5 (< 60 mL/min/1.73 m
2
) was classified as CKD. Hospital medical records were extensively scrutinized from inclusion to endpoint (death or end of 2016). The prevalence of CKD was compared to a control group from the population-based prospective cohort Malmö Preventive Project (MPP). Results: 120 patients with biopsy-proven NAFLD were included. Mean age was 52.5 years and mean follow-up time 19.5 years. At baseline CKD prevalence in NAFLD was only significantly higher in the highest age group compared to controls (> 55 years, 25% vs. 9.5%, P = 0.003), and no significant difference was seen at follow-up (in total 37.5% vs. 30.8%, P = 0.124). NAFLD patients with long-term CKD had significantly higher crude overall mortality rate than NAFLD patients without CKD (P < 0.001). Regression analyses revealed that this increased mortality risk was explained by an increased prevalence of metabolic comorbidities (including diabetes mellitus), not CKD. Conclusion: Mortality risk is significantly increased in NAFLD patients with long-term CKD due to metabolic comorbidities, not influenced by CKD per se.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Chronic kidney disease, Epidemiology, liver cirrhosis, Liver fibrosis, Metabolic syndrome, Mortality, non-alcoholic fatty liver disease
in
Clinics and Research in Hepatology and Gastroenterology
external identifiers
  • scopus:85062090276
ISSN
2210-7401
DOI
10.1016/j.clinre.2019.02.004
language
English
LU publication?
yes
id
682a4c8b-cf23-4c30-92a5-eb8bf034e6fb
date added to LUP
2019-03-06 14:13:44
date last changed
2019-04-02 04:14:32
@article{682a4c8b-cf23-4c30-92a5-eb8bf034e6fb,
  abstract     = {<p><br>
                                                         Background: There is a close association between non-alcoholic fatty liver disease (NAFLD) and prevalent chronic kidney disease (CKD). Few longitudinal studies exist. No previous study has investigated to what extent CKD affects mortality in biopsy-proven NAFLD. Our aim was to investigate the long-term risk of developing CKD in biopsy-proven NAFLD and its effect on mortality. Methods: Patients with biopsy-proven NAFLD diagnosed in 1978-2006 in Malmö, Sweden were included. Estimated glomerular filtration rate (eGFR) at baseline and last follow-up was calculated with the CKD-EPI equation. CKD 3–5 (&lt; 60 mL/min/1.73 m                             <br>
                            <sup>2</sup><br>
                                                         ) was classified as CKD. Hospital medical records were extensively scrutinized from inclusion to endpoint (death or end of 2016). The prevalence of CKD was compared to a control group from the population-based prospective cohort Malmö Preventive Project (MPP). Results: 120 patients with biopsy-proven NAFLD were included. Mean age was 52.5 years and mean follow-up time 19.5 years. At baseline CKD prevalence in NAFLD was only significantly higher in the highest age group compared to controls (&gt; 55 years, 25% vs. 9.5%, P = 0.003), and no significant difference was seen at follow-up (in total 37.5% vs. 30.8%, P = 0.124). NAFLD patients with long-term CKD had significantly higher crude overall mortality rate than NAFLD patients without CKD (P &lt; 0.001). Regression analyses revealed that this increased mortality risk was explained by an increased prevalence of metabolic comorbidities (including diabetes mellitus), not CKD. Conclusion: Mortality risk is significantly increased in NAFLD patients with long-term CKD due to metabolic comorbidities, not influenced by CKD per se.                         <br>
                        </p>},
  author       = {Önnerhag, Kristina and Dreja, Karl and Nilsson, Peter M. and Lindgren, Stefan},
  issn         = {2210-7401},
  keyword      = {Chronic kidney disease,Epidemiology, liver cirrhosis,Liver fibrosis,Metabolic syndrome,Mortality,non-alcoholic fatty liver disease},
  language     = {eng},
  month        = {03},
  series       = {Clinics and Research in Hepatology and Gastroenterology},
  title        = {Increased mortality in non-alcoholic fatty liver disease with chronic kidney disease is explained by metabolic comorbidities},
  url          = {http://dx.doi.org/10.1016/j.clinre.2019.02.004},
  year         = {2019},
}