Measuring for nonalcoholic fatty liver disease in patients with type 1 diabetes may improve the risk prediction for chronic kidney disease, according to findings published in Diabetes Care.
A study by Giovanni Targher, MD, of the University of Verona in Italy, is the first to demonstrate that nonalcoholic fatty liver disease (NAFLD) is strongly linked to an increased incidence of CKD.
Targher and colleagues followed 261 adults with type 1 diabetes with preserved kidney function and no macroalbuminuria at baseline for an average of 5.2 years. The researchers investigated the occurrence of CKD, defined as estimated glomerular filtration rate <60 mL/min/1.73 m², and/or macroalbuminuria. Ultrasonography was used to diagnose NAFLD.
The average eGFR at baseline was 92 ± 23 mL/min/1.73 m². Normoalbuminuria was present in 234 patients (89.7%), microalbuminuria in 27 (10.3%) and NAFLD in 131 (50.2%). During follow-up, 61 patients developed incident CKD.
NAFLD was associated with an increased risk for incident CKD (HR=2.85; 95% CI, 1.59–5.1).
The association did not appreciably diminish with adjustments for age, sex, duration of diabetes, hypertension, HbA1c and baseline eGFR (adjusted HR=2.03; 95% CI, 1.1-3.77).
No changes were seen after excluding those who had microalbuminuria at baseline (adjusted HR=1.85; 95% CI, 1.03-3.27).
The regression models for predicting CKD showed significant capability improvements when NAFLD was added to the traditional risk factors.
“This is the first study to demonstrate that NAFLD is strongly associated with an increased incidence of CKD,” the researchers wrote, “and that measurement of NAFLD improves the risk prediction of CKD, independently of traditional cardio-renal risk factors, in adults with type 1 diabetes.”
Disclosure: Targher was supported in part by grants from the University of Verona School of Medicine. Another researcher was supported in part by the Southampton National Institute for Health Research Biomedical Research Centre.