Publication:
Association of Non-alcoholic Fatty Liver Disease with Chronic Kidney Disease: A Systematic Review and Meta-analysis

Issued Date

2014-01-01

Resource Type

Article

ISSN

15491676
15491277

DOI

10.1371/journal.pmed.1001680

Other identifier(s)

2-s2.0-84905401784

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

PLoS Medicine. Vol.11, No.7 (2014)

Suggested Citation

Giovanni Musso, Roberto Gambino, James H. Tabibian, Mattias Ekstedt, Stergios Kechagias, Masahide Hamaguchi, Rolf Hultcrantz, Hannes Hagström, Seung Kew Yoon, Phunchai Charatcharoenwitthaya, Jacob George, Francisco Barrera, Svanhildur Haflidadóttir, Einar Stefan Björnsson, Matthew J. Armstrong, Laurence J. Hopkins, Xin Gao, Sven Francque, An Verrijken, Yusuf Yilmaz, Keith D. Lindor, Michael Charlton, Robin Haring, Markus M. Lerch, Rainer Rettig, Henry Völzke, Seungho Ryu, Guolin Li, Linda L. Wong, Mariana Machado, Helena Cortez-Pinto, Kohichiroh Yasui, Maurizio Cassader Association of Non-alcoholic Fatty Liver Disease with Chronic Kidney Disease: A Systematic Review and Meta-analysis. PLoS Medicine. Vol.11, No.7 (2014). doi:10.1371/journal.pmed.1001680 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/34880

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Title

Association of Non-alcoholic Fatty Liver Disease with Chronic Kidney Disease: A Systematic Review and Meta-analysis

Author(s)

Giovanni Musso
 Roberto Gambino
 James H. Tabibian
 Mattias Ekstedt
 Stergios Kechagias
 Masahide Hamaguchi
 Rolf Hultcrantz
 Hannes Hagström
 Seung Kew Yoon
 Phunchai Charatcharoenwitthaya
 Jacob George
 Francisco Barrera
 Svanhildur Haflidadóttir
 Einar Stefan Björnsson
 Matthew J. Armstrong
 Laurence J. Hopkins
 Xin Gao
 Sven Francque
 An Verrijken
 Yusuf Yilmaz
 Keith D. Lindor
 Michael Charlton
 Robin Haring
 Markus M. Lerch
 Rainer Rettig
 Henry Völzke
 Seungho Ryu
 Guolin Li
 Linda L. Wong
 Mariana Machado
 Helena Cortez-Pinto
 Kohichiroh Yasui
 Maurizio Cassader

Other Contributor(s)

Universita degli Studi di Torino
 Mayo Clinic
 Linkopings universitet
 Osaka University
 Karolinska University Hospital
 The Catholic University of Korea, College of Medicine
 Mahidol University
 The University of Sydney
 Landspitali University Hospital
 University of Birmingham
 Fudan University
 Universitair Ziekenhuis Antwerpen
 Marmara Universitesi
 Ernst-Moritz-Arndt-Universitat Greifswald
 University Medicine Greifswald
 Sungkyunkwan University
 Hunan Normal University
 University of Hawaii at Manoa John A. Burns School of Medicine
 Santa Maria Hospital, Lisbon
 Kyoto Prefectural University of Medicine

Abstract

Background:Chronic kidney disease (CKD) is a frequent, under-recognized condition and a risk factor for renal failure and cardiovascular disease. Increasing evidence connects non-alcoholic fatty liver disease (NAFLD) to CKD. We conducted a meta-analysis to determine whether the presence and severity of NAFLD are associated with the presence and severity of CKD.Methods and Findings:English and non-English articles from international online databases from 1980 through January 31, 2014 were searched. Observational studies assessing NAFLD by histology, imaging, or biochemistry and defining CKD as either estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2or proteinuria were included. Two reviewers extracted studies independently and in duplicate. Individual participant data (IPD) were solicited from all selected studies. Studies providing IPD were combined with studies providing only aggregate data with the two-stage method. Main outcomes were pooled using random-effects models. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. The influences of age, whole-body/abdominal obesity, homeostasis model of insulin resistance (HOMA-IR), and duration of follow-up on effect estimates were assessed by meta-regression. Thirty-three studies (63,902 participants, 16 population-based and 17 hospital-based, 20 cross-sectional, and 13 longitudinal) were included. For 20 studies (61% of included studies, 11 cross-sectional and nine longitudinal, 29,282 participants), we obtained IPD. NAFLD was associated with an increased risk of prevalent (odds ratio [OR] 2.12, 95% CI 1.69-2.66) and incident (hazard ratio [HR] 1.79, 95% CI 1.65-1.95) CKD. Non-alcoholic steatohepatitis (NASH) was associated with a higher prevalence (OR 2.53, 95% CI 1.58-4.05) and incidence (HR 2.12, 95% CI 1.42-3.17) of CKD than simple steatosis. Advanced fibrosis was associated with a higher prevalence (OR 5.20, 95% CI 3.14-8.61) and incidence (HR 3.29, 95% CI 2.30-4.71) of CKD than non-advanced fibrosis. In all analyses, the magnitude and direction of effects remained unaffected by diabetes status, after adjustment for other risk factors, and in other subgroup and meta-regression analyses. In cross-sectional and longitudinal studies, the severity of NAFLD was positively associated with CKD stages. Limitations of analysis are the relatively small size of studies utilizing liver histology and the suboptimal sensitivity of ultrasound and biochemistry for NAFLD detection in population-based studies.Conclusion:The presence and severity of NAFLD are associated with an increased risk and severity of CKD.Please see later in the article for the Editors' Summary. © 2014 Musso et al.

Keyword(s)

Medicine

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URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/34880

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