Non-alcoholic fatty liver disease worsens cardiovascular outcomes in patients with kidney disease

1. In patients with CKD, non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular events (CVE), while the NAFLD fibrosis score was independently associated with higher all-cause mortality (ACM) and CVE risk

Evidence Rating Level: 1 (Evidence)

Affecting a quarter of adults, NAFLD is characterized by the accumulation of excess fat in the liver and serves as an independent risk factor for cardiovascular disease and mortality. Likewise, chronic kidney disease (CKD) is associated with diminished quality of life, an elevated risk of end-stage renal disease (ESRD), cardiovascular disease, and premature mortality. The implications of having both CKD and NAFLD are poorly understood, therefore this large prospective cohort study was performed to assess the independent associations of NAFLD and NAFLD with advanced liver fibrosis with the risks of CVE, ESRD, and ACM in individuals with CKD. After excluding individuals who had a baseline CVE, already developed ESRD, or had a non-NAFLD cause of liver disease, 18,073 participants with CKD were identified from the UK Biobank (UKBB), a prospective cohort study aimed at improving disease prevention. In this cohort 56.2% (n = 10,152) of people had NAFLD. Univariate analysis demonstrated that NAFLD was associated with a higher incidence of all CVE (HR 1.49 [1.38–1.60], p < 0.0001), ACM (HR 1.22 [1.14–1.31], p < 0.0001), and ESRD (HR 1.26 [1.02–1.54], p = 0.0298). After multivariable adjustment for age, sex, ethnicity, deprivation, alcohol, smoking, baseline renal function, and diabetes, NAFLD only remained an independent risk factor for CVE overall. When examining the effects of liver fibrosis in a multivariable analysis, an NAFLD fibrosis score (NFS) ≥ 0.676 was associated with an increased risk of all CVE (HR 1.19 [1.01–1.40], p = 0.0424) particularly HF (HR 1.65 [1.36–2.01], p < 0.0001), and ACM (HR 1.31 [1.13–1.52], p = 0.0005). Overall, NAFLD is significantly associated with CVE and not ACM or ESRD as demonstrated by the multivariate analysis. In the setting of advanced fibrosis, NFS was independently related to ACM and CVE, in particular, heart failure. These findings underscore the significant correlation between the kidneys and the liver and warrant further investigation into the mechanism of this association.

Click to read the study in BMC Medicine

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