Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: an updated meta-analysis
Open accessAbstract
Objective Studies reported a significant association between non-alcoholic fatty liver disease (NAFLD) and increased risk of chronic kidney disease (CKD). However, whether this risk changes with increasing severity of NAFLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and risk of incident CKD. Design We systematically searched PubMed, Web of Science and Scopus from January 2000 to August 2020 using predefined keywords to identify observational studies with a follow-up duration of ≥1 year, in which NAFLD was diagnosed by blood biomarkers/scores, International Classification of Diseases codes, imaging techniques or biopsy. Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling. Results 13 studies with 1 222 032 individuals (28.1% with NAFLD) and 33 840 cases of incident CKD stage ≥3 (defined as estimated glomerular filtration rate <60 mL/min/1.73 m 2 , with or without accompanying overt proteinuria) over a median follow-up of 9.7 years were included. NAFLD was associated with a moderately increased risk of incident CKD (n=10 studies; random-effects HR 1.43, 95% CI 1.33 to 1.54; I 2 =60.7%). All risks were independent of age, sex, obesity, hypertension, diabetes and other conventional CKD risk factors. Sensitivity analyses did not alter these findings. Funnel plot did not reveal any significant publication bias. Conclusion This large and updated meta-analysis indicates that NAFLD is significantly associated with a~1.45-fold increased long-term risk of incident CKD stage ≥3. Further studies are needed to examine the association between the severity of NAFLD and risk of incident CKD.
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In a large meta-analysis including 1,222,032 individuals, the risk of incident chronic kidney disease stage >=3 was 1.45-fold higher in individuals with MASLD, independent of demographic and CKD risk factors.
“In a large meta-analysis including 1,222,032 individuals, the risk of incident chronic kidney disease (CKD) stage > -3 was 1.45-fold higher in individuals with MASLD, independent of demographic and CKD risk factors. 226”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [226]
The Discussion reports 1,222,032 participants and an approximately 1.45-fold higher risk of incident CKD stage ≥3; the 'NAFLD increases risk of CKD' section gives the pooled adjusted HR as 1.43. The paper studied NAFLD, not MASLD, and the pooled risk estimate came from 1,215,872 participants rather than all 1,222,032. (LLM, conf=0.85)
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- Authors
- Mantovani, A., Petracca, G., Beatrice, G., Csermely, A., Lonardo, A., Schattenberg, J. M., Tilg, H., Byrne, C. D., & Targher, G.
- Affiliations
- University of Verona (IT)
- University of Modena and Reggio Emilia (IT)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Innsbruck Medical University (AT)
- University of Southampton (GB)
- Corresponding author
- Targher, Giovanni
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2020-12-10
- Volume
- 71
- Issue
- 1
- Pages
- 156-162
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W3111270904
- Cited by
- 402
- References
- 45
- Citations by year
- 2026: 78 · 2025: 69 · 2024: 80 · 2023: 72 · 2022: 58 · 2021: 42 · 2020: 2 · 2012: 1
- FWCI
- 6.36
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.soton.ac.uk
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, chronic kidney disease, incident CKD risk, estimated glomerular filtration rate, proteinuria, NAFLD severity, CKD risk factors
- MeSH terms
- Humans, Risk Assessment, Renal Insufficiency, Chronic, Observational Studies as Topic, Non-alcoholic Fatty Liver Disease
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