Review Article

Chronic Kidney Disease and Nonalcoholic Fatty Liver Disease—Is There a Link?

Table 1

Cross-sectional and prospective studies of the association between chronic kidney disease and NAFLD.

AuthorsStudy populationDiagnosis of NAFLDStudy measuresMain findings

Targher et al. [25]2103 diabetic patientsUltrasoundeGFR ≤ 60 mL/min/1.73 m2 or over proteinuriaThe prevalence of CKD was higher among patients with NAFLD than among without NAFLD ( )

Targher et al. [26]202 type 1 diabetic patientsUltrasoundeGFR ≤ 60 mL/min/1.73 m2 or urinary alb/creat ratio ≥ 30 mg/gNAFLD is associated with increased risk of prevalent CKD

Hwang et al. [27]1.361 patients with impaired glucose tolerance or newly diagnosed diabetesUltrasoundUrinary alb/creat ratio ≥ 30 mg/gNAFLD is associated with increased risk of prevalent microalbuminuria

Targher et al. [28]National Health and Nutritional Examination Survey (NHANES) 2001–2006; involved 13188 patientsLiver enzymes (GGT)eGFR ≤ 60 mL/min/1.73 m2 or urinary alb/creat ratio ≥ 30 mg/gElevated serum levels of GGT were associated with prevalent CKD

Yun et al. [29]Health-examination survey of 37085 individualsLiver enzymes (ALT)eGFRIndividuals with ALT > 40 U/L had lower eGFR than those with ALT < 40 U/L

Lee et al. [30]Framingham Heart Study; involved 3451 subjectsLiver enzymes (GGT)Serum creatinineNo differences

Mikolasevic et al. [16]75 patients with CKD stage III and IVTransient elastography (Fibroscan-CAP)eGFR ≤ 60 mL/min/1.73 m2High prevalence of NAFLD in CKD patients. The severity of liver steatosis (defined by CAP values) was negatively correlated with kidney function

Yilmaz et al. [31]87 NAFLD patientsBiopsy24 hrs urinary albumin excretion rateMicroalbuminuria is associated with IR and liver fibrosis in NAFLD patients

Manco et al. [32]80 overweight or obese children with NAFLD and 59 age- and sex-matched childrenBiopsyCreatinine clearance and 24 hr urinary albumin excretion rateNo difference

Targher et al. [33]80 NASH patients matched with age-, sex- and BMI matched subjects without steatosisBiopsyeGFR ≤ 60 mL/min/1.73 m2 or urinary alb/creat ratio ≥ 30 mg/gNASH patients had higher frequency of CKD

Targher et al. [34]Valpolicella Heart Diabetes Study; 1760 type 2 diabetic patients with normal kidney function; length of follow-up: 6.5 yearsUltrasonography eGFR ≤ 60 mL/min/1.73 m2 or overt proteinuriaNAFLD is associated with increased risk of incident CKD

Ryu et al. [35]10.337 non-diabetic and non-hypertensive patients with normal kidney function; length of followup: 2.5 yearsLiver enzymes (GGT)eGFR ≤ 60 mL/min/1.73 m2 or overt proteinuriaElevated serum GGT levels are associated with increased risk of incident CKD

Estimated glomerular filtration rate (eGFR); nonalcoholic fatty liver disease (NAFLD); albumin (Alb); creatinine (Creat); alanine aminotransferase (ALT); gamma-glutamyltransferase (GGT); body mass index (BMI); controlled attenuation parameter (CAP).