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Metabolic dysfunction-associated fatty liver disease increases risk of chronic kidney disease: a systematic review
Jianghua Zhou1, Dan-Qin Sun2, Giovanni Targher3
1Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Background And Aim:
Metabolic dysfunction-associated fatty liver disease (MAFLD) is an alternative description and classification of non-alcoholic fatty liver disease (NAFLD) that may have better utility than NAFLD in clinical practice. We performed a meta-analysis to quantify the magnitude of the association between MAFLD and risk of both prevalent and incident chronic kidney disease (CKD).
Methods:
We systematically searched PubMed, Medline (OVID), Embase (OVID), Web of Science and Cochrane Library from database inception until 29 May 2022. We included observational studies examining the association between MAFLD and risk of CKD, defined by estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or presence of abnormal albuminuria. Meta-analysis was performed using random-effects models to obtain summary HRs or ORs with 95% CIs.
Results:
Seventeen observational studies with aggregate data on 845 753 participants were included in meta-analysis. In the 7 cohort studies, the pooled random-effects HR for incident CKD in patients with MAFLD was 1.29 (95% CI 1.17 to 1.41, I2=87.0%). In the 10 cross-sectional studies, the pooled random-effects OR for prevalent CKD in patients with MAFLD was 1.35 (95% CI 1.11 to 1.64, I2=92.6%).
Conclusion:
MAFLD is significantly associated with an increased prevalence and incidence of CKD.
Prospero Registration Number:
CRD42022352366.
Insights
Metabolic dysfunction-associated fatty liver disease (MAFLD) significantly increases the risk of developing chronic kidney disease (CKD). This meta-analysis confirms MAFLD is linked to both prevalent and incident CKD.
Area of Science:
- Nephrology
- Hepatology
- Metabolic Diseases
Background:
- Metabolic dysfunction-associated fatty liver disease (MAFLD) is a proposed reclassification of non-alcoholic fatty liver disease (NAFLD).
- MAFLD may offer improved clinical utility compared to the NAFLD classification.
- The association between MAFLD and chronic kidney disease (CKD) requires further investigation.
Purpose of the Study:
- To quantify the association between MAFLD and the risk of prevalent and incident CKD.
- To synthesize evidence from observational studies on MAFLD and CKD risk.
Main Methods:
- Systematic literature search of multiple databases (PubMed, Medline, Embase, Web of Science, Cochrane Library) until May 2022.
- Inclusion of observational studies assessing MAFLD and CKD (defined by eGFR ≤60 mL/min/1.73 m² or albuminuria).
- Meta-analysis using random-effects models to calculate pooled Hazard Ratios (HRs) and Odds Ratios (ORs) with 95% Confidence Intervals (CIs).
Main Results:
- Seventeen observational studies with 845,753 participants were included.
- MAFLD was associated with a 29% increased risk of incident CKD (HR 1.29, 95% CI 1.17-1.41) in cohort studies.
- MAFLD was associated with a 35% increased risk of prevalent CKD (OR 1.35, 95% CI 1.11-1.64) in cross-sectional studies.
Conclusions:
- MAFLD demonstrates a significant association with an increased prevalence of CKD.
- MAFLD is also significantly linked to a higher incidence of CKD.
- The findings support MAFLD as a relevant factor in CKD development.
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