Research Article: The fatty liver index as a predictor of incident chronic kidney disease in a 10-year prospective cohort study

Date Published: July 24, 2017

Publisher: Public Library of Science

Author(s): Ji Hye Huh, Jang Young Kim, Eunhee Choi, Jae Seok Kim, Yoosoo Chang, Ki-Chul Sung, Tatsuo Shimosawa.


Although non-alcoholic fatty liver disease (NAFLD) is considered to be associated with chronic kidney disease (CKD), long-term follow up data is lacking. We investigated whether NAFLD, as determined by the fatty liver index (FLI), could predict incident CKD in 10-year prospective cohort study. We also assessed the clinical utility of FLI to predict the development of CKD.

6,238 adults aged 40 to 69 years without baseline CKD from the Ansan—Ansung cohort were examined. Patients were classified according to FLI as follows: FLI<30, no NAFLD; FLI≥60, NAFLD; and 30≤ FLI<60, intermediate. Incident CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. The clinical utility of FLI in predicting incident CKD was estimated via area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses. During an average of 10 years of follow-up, 724 subjects (15.21%) developed CKD. The adjusted hazard ratio [95% confidence interval (CI)] for incident CKD increased in a graded manner with FLI increased (<30 vs. 30–59 vs. ≥60 = 1 vs. 1.17 [0.997–1.375] vs. 1.459 [1.189–1.791], respectively, P for trend = 0.0012). Incorporation of FLI into traditional risk factors of CKD significantly increased prediction of incident CKD based on NRI (17%; 95% CI, 8.9–25%; P-value <0.001) and IDI (0.002; 95% CI, 0.0046–0.0143; P-value = 0.046). FLI, a surrogate marker of NAFLD, was an independent risk factor for incident CKD. FLI provides meaningful incremental risk reclassification beyond that of conventional risk factors of CKD.

Partial Text

Chronic kidney disease (CKD) has become a worldwide health problem that results in high morbidity and mortality in various chronic diseases, consuming substantial healthcare costs. The prevalence of CKD in developed countries has been reported as approximately 10–15% of the adult population and is expected to rise in the future as populations age and the prevalence of obesity and diabetes mellitus increase [1–3]. Recently, CKD has come to be considered a risk factor for not only end-stage renal disease, but also cardiovascular disease, even in the early stages of renal dysfunction. Furthermore, a large body of data indicates that CKD is associated with all-cause mortality, premature death, cognitive impairment, and poor quality of life. Therefore, it is important to identify other modifiable risk factors of CKD in addition to traditional risk factors such as obesity, diabetes mellitus, and hypertension.

In our current large prospective cohort study, we found that the presence of NAFLD, as assessed by FLI, is associated with incident CKD independent of traditional risk factors (i.e., DM and hypertension) during a 10-year period. Our findings support the application of NAFLD as a risk factor in the early pathogenesis of CKD. Furthermore, we found that the addition of FLI to traditional CKD risk factors improved the prediction of incident CKD, including risk reclassification metrics. To the best of our knowledge, this is the first prospective cohort study to explore the clinical utility of FLI on risk prediction of incident CKD.




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