Association of Non-alcoholic Fatty Liver Disease with Chronic Kidney Disease: A Systematic Review and Meta-analysis

被引：542

作者：

Musso, Giovanni ^{[1
]}

Gambino, Roberto ^{[2
]}

Tabibian, James H. ^{[3
]}

Ekstedt, Mattias ^{[4
]}

Kechagias, Stergios ^{[5
]}

Hamaguchi, Masahide ^{[6
]}

Hultcrantz, Rolf ^{[7
,8
]}

Hagstrom, Hannes ^{[7
,8
]}

Yoon, Seung Kew ^{[9
]}

Charatcharoenwitthaya, Phunchai ^{[10
]}

George, Jacob ^{[11
,12
]}

Barrera, Francisco ^{[11
,12
]}

Haflioadottir, Svanhildur ^{[13
]}

Bjornsson, Einar Stefan ^{[13
]}

Armstrong, Matthew J. ^{[14
,15
]}

Hopkins, Laurence J. ^{[14
,15
]}

Gao, Xin ^{[16
]}

Francque, Sven ^{[17
]}

Verrijken, An ^{[18
]}

Yilmaz, Yusuf ^{[19
]}

Lindor, Keith D. ^{[3
]}

Charlton, Michael ^{[3
]}

Haring, Robin ^{[20
]}

Lerch, Markus M. ^{[21
]}

Rettig, Rainer ^{[22
]}

Voelzke, Henry ^{[23
]}

Ryu, Seungho ^{[24
]}

Li, Guolin ^{[25
]}

Wong, Linda L. ^{[26
]}

Machado, Mariana ^{[27
]}

Cortez-Pinto, Helena ^{[27
]}

Yasui, Kohichiroh ^{[28
]}

Cassader, Maurizio ^{[2
]}

机构：

[1] Univ Turin, Gradenigo Hosp, Turin, Italy

[2] Univ Turin, San Giovanni Battista Hosp, Dept Med Sci, Turin, Italy

[3] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN USA

[4] Linkoping Univ, Div Gastroenterol & Hepatol, Linkoping, Sweden

[5] Linkoping Univ, Dept Med & Hlth Sci, Div Cardiovasc Med, Linkoping, Sweden

[6] Osaka Univ, World Premier Int Immunol Frontier Res Ctr, Dept Expt Immunol, Osaka, Japan

[7] Karolinska Inst, Karolinska Univ Hosp, Dept Gastroenterol, Stockholm, Sweden

[8] Karolinska Inst, Karolinska Univ Hosp, Dept Hepatol, Stockholm, Sweden

[9] Catholic Univ, Coll Med, Kangnam St Mary Hosp, Div Hepatogastroenterol,Dept Internal Med, Seoul, South Korea

[10] Mahidol Univ, Div Gastroenterol, Dept Med, Siriraj Hosp, Bangkok 10700, Thailand

[11] Univ Sydney, Westmead Millennium Inst, Storr Liver Unit, Westmead, NSW 2145, Australia

[12] Westmead Hosp, Dept Gastroenterol & Hepatol, Westmead, NSW 2145, Australia

[13] Landspitali Univ Hosp, Dept Gastroenterol & Hepatol, Reykjavik, Iceland

[14] Univ Birmingham, Inst Biomed Res, Liver Res Ctr, Birmingham, W Midlands, England

[15] Univ Birmingham, NIHR Biomed Res Unit Liver Dis, Inst Biomed Res, Birmingham, W Midlands, England

[16] Fudan Univ, Zhongshan Hosp, Dept Endocrinol & Metab, Shanghai 200433, Peoples R China

[17] Univ Antwerp, Dept Gastroenterol & Hepatol, Univ Antwerp Hosp, B-2020 Antwerp, Belgium

[18] Univ Antwerp, Univ Antwerp Hosp, Dept Endocrinol Diabetol & Metab, B-2020 Antwerp, Belgium

[19] Marmara Univ, Sch Med, Dept Gastroenterol, Istanbul, Turkey

[20] Univ Greifswald, Inst Clin Chem & Lab Med, Greifswald, Germany

[21] Univ Med Greifswald, Dept Med A, Greifswald, Germany

[22] Ernst Moritz Arndt Univ Med Greifswald, Inst Physiol, Karlsburg, Germany

[23] Ernst Moritz Arndt Univ Med Greifswald, Inst Community Med, Greifswald, Germany

[24] Sungkyunkwan Univ, Sch Med, Dept Occupat & Environm Med, Kangbuk Samsung Hosp, Seoul, South Korea

[25] Hunan Normal Univ, Coll Life Sci, Changsha, Hunan, Peoples R China

[26] Univ Hawaii, John A Burns Sch Med, Transplant Inst, Hawaii Med Ctr, Honolulu, HI 96822 USA

[27] Univ Hosp Santa Maria, Dept Gastroenterol, Inst Mol Med, Lisbon, Portugal

[28] Kyoto Prefectural Univ Med, Dept Mol Gastroenterol & Hepatol, Kyoto 602, Japan

来源：

PLOS MEDICINE | 2014年 / 11卷 / 07期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

INDIVIDUAL PARTICIPANT DATA; RENAL-FUNCTION; INCREASED PREVALENCE; PRACTICE GUIDELINE; METABOLIC SYNDROME; AMERICAN-COLLEGE; SERUM CREATININE; PUBLICATION BIAS; FETUIN-A; MICROALBUMINURIA;

D O I：

10.1371/journal.pmed.1001680

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Chronic kidney disease (CKD) is a frequent, under-recognized condition and a risk factor for renal failure and cardiovascular disease. Increasing evidence connects non-alcoholic fatty liver disease (NAFLD) to CKD. We conducted a meta-analysis to determine whether the presence and severity of NAFLD are associated with the presence and severity of CKD. Methods and Findings: English and non-English articles from international online databases from 1980 through January 31, 2014 were searched. Observational studies assessing NAFLD by histology, imaging, or biochemistry and defining CKD as either estimated glomerular filtration rate (eGFR),60 ml/min/1.73 m(2) or proteinuria were included. Two reviewers extracted studies independently and in duplicate. Individual participant data (IPD) were solicited from all selected studies. Studies providing IPD were combined with studies providing only aggregate data with the two-stage method. Main outcomes were pooled using random-effects models. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. The influences of age, whole-body/abdominal obesity, homeostasis model of insulin resistance (HOMA-IR), and duration of follow-up on effect estimates were assessed by meta-regression. Thirty-three studies (63,902 participants, 16 population-based and 17 hospital-based, 20 cross-sectional, and 13 longitudinal) were included. For 20 studies (61% of included studies, 11 cross-sectional and nine longitudinal, 29,282 participants), we obtained IPD. NAFLD was associated with an increased risk of prevalent (odds ratio [OR] 2.12, 95% CI 1.69-2.66) and incident (hazard ratio [HR] 1.79, 95% CI 1.65-1.95) CKD. Non-alcoholic steatohepatitis (NASH) was associated with a higher prevalence (OR 2.53, 95% CI 1.58-4.05) and incidence (HR 2.12, 95% CI 1.42-3.17) of CKD than simple steatosis. Advanced fibrosis was associated with a higher prevalence (OR 5.20, 95% CI 3.14-8.61) and incidence (HR 3.29, 95% CI 2.30-4.71) of CKD than non-advanced fibrosis. In all analyses, the magnitude and direction of effects remained unaffected by diabetes status, after adjustment for other risk factors, and in other subgroup and meta-regression analyses. In cross-sectional and longitudinal studies, the severity of NAFLD was positively associated with CKD stages. Limitations of analysis are the relatively small size of studies utilizing liver histology and the suboptimal sensitivity of ultrasound and biochemistry for NAFLD detection in population-based studies. Conclusion: The presence and severity of NAFLD are associated with an increased risk and severity of CKD.

引用

页数：26

共 89 条

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