MAFLD Significantly Associated With Increased Prevalence, Incidence of CKD

Ming-Hua Zheng, MD, PhD

Credit: ResearchGate

A recent meta-analysis of 17 observational studies found a significant association between metabolic dysfunction-associated fatty liver disease (MAFLD) and increased prevalence and incidence of chronic kidney disease (CKD).

“The results of this updated meta-analysis provide evidence that the presence of MAFLD is significantly associated with an increased prevalence and incidence of CKD. Our findings suggest that MAFLD might become a target for the prevention and treatment of CKD,” wrote investigators.¹

In 2020, a new definition was proposed for MALFD, an alternative description and classification of non-alcoholic fatty liver disease (NAFLD), that would not require the exclusion of other etiologies of hepatic steatosis, leading to suggestions that MAFLD could replace NAFLD in clinical practice and research studies. Further reports suggest that MAFLD may progress to cirrhosis and promote the development of extrahepatic diseases like CKD.¹

About 14% of US adults are estimated to have CKD. As many as 9 in 10 adults with CKD, and 1 in 3 with severe CKD, don’t know they have it.²

In order to further estimate associations between MAFLD and CKD, investigators performed a comprehensive meta-analysis of 17 observational studies to quantify the magnitude of association between MAFLD and the risk of prevalent and incident CKD, defined by estimated glomerular filtration rate ≤ 60mL/min/1.73 m2 or presence of abnormal albuminuria, using random-effects models to obtain summary hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs).¹

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 authors independently selected published articles from the electronic databases PubMed, Medline (OVID), Embase (OVID), Web of Science and Cochrane Library. They first screened titles and abstracts, and later relevant full texts based on the following inclusion criteria:

• Longitudinal cohort studies or cross-section studies
• Studies investigating the link between MAFLD and CKD risk
• Adult individuals of any sex or ethnicity
• Studies with a diagnosis of MAFLD and CKD
• Hepatic steatosis diagnosis by liver histology, imaging methods, or biomarker panels

The investigators’ initial search returned 3400 published articles. After exclusion of all nonobservational studies and the elimination of duplicates, investigators identified 17 studies for inclusion in their meta-analysis. This group of 17 included 10 cross-sectional studies and 7 retrospective cohort studies, with a combined population of 845,753 individuals.¹

In the 7 cohort studies, pooled random effects HR for incident CKD in patients with MAFLD was 1.29 (95% CI, 1.17-1.41; I2=87.0%; P < .001). In the 10 cross-sectional studies, pooled-random effects OR for prevalent CKD in patients with MALFD was 1.35 (95% CI, 1.11-1.64; I2=92.6%; P < .001). Further analysis of the combined cohort suggested MAFLD was significantly associated with about 30% increased risk of prevalent and incident CKD.¹

Investigators noted MAFLD patients with greater severity of fibrosis experienced a greater risk of CKD and also pointed out the magnitude of risk remained unchanged after stratification by study country, modality of MAFLD diagnosis, CKD definition, and study quality.¹

“To the best of our knowledge, the present meta-analysis assessing the association between MAFLD and the risk of prevalent and incident CKD is the largest and most comprehensive assessment of this association to date,” concluded investigators.¹

References:

1. Zhou J, Sun D-Q, Targher G, et al. Metabolic dysfunction-associated fatty liver disease increases risk of chronic kidney disease: A systematic review and meta-analysis. eGastroenterology. 2023;1(1). doi:10.1136/egastro-2023-100005
2. Chronic kidney disease in the United States, 2023. Centers for Disease Control and Prevention. May 30, 2023. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html.