Risk Stratification of Chronic Kidney Disease in Adults Using Noninvasive Fibrosis Tests Based on the American...

Area of Science:

• Hepatology
• Nephrology
• Cardiometabolic Health

Background:

• The American Diabetes Association (ADA) developed a diagnostic algorithm for early liver fibrosis detection in high-risk populations.
• The utility of this ADA algorithm for stratifying chronic kidney disease (CKD) risk, particularly in individuals at risk for cirrhosis, is not well-established.
• Accurate CKD risk stratification is crucial for timely intervention and management in at-risk populations.

Purpose of the Study:

• To evaluate the effectiveness of the ADA diagnostic algorithm in stratifying CKD risk among individuals at risk of developing cirrhosis.
• To assess the association between the ADA algorithm-based risk categories and the incidence of CKD and its progression.

Main Methods:

• Retrospective cohort study involving 9264 adults without pre-existing CKD.
• Participants were categorized using the ADA algorithm based on FIB-4 index and liver stiffness (LS) measurements.
• Primary outcome: incident CKD (eGFR < 60 mL/min/1.73 m² or proteinuria). Secondary outcomes: 25% eGFR decline, CKD risk at 3 and 5 years.

Main Results:

• Over a mean follow-up of 3.7 years, 4.7% of participants developed incident CKD.
• The high-risk group, as defined by the ADA algorithm, showed a 1.52-fold increased risk of incident CKD compared to those with no metabolic abnormalities.
• The high-risk group also exhibited a 2.30-fold higher risk of a 25% eGFR decline.

Conclusions:

• The two-step ADA algorithm demonstrates effectiveness in stratifying CKD risk.
• This algorithm can identify individuals at high risk for future CKD, especially those with potential cirrhosis.
• The findings support the use of the ADA algorithm for enhanced CKD risk assessment in relevant patient populations.