Association Between Metabolic Associated Fatty Liver Disease and Chronic Kidney Disease: A Cross-Sectional Study from NHANES 2017-2018

Purpose: In 2020, an international expert consensus proposed a novel concept, defined as metabolic associated fatty liver disease (MAFLD). We aimed to investigate the association between MAFLD and chronic kidney disease (CKD). Methods: A total of 4869 subjects with demographic data, laboratory tests, and ultrasound transient elastography from National Health and Nutrition Examination Surveys of the United States (NHANES) 2017-2018 were included in the study. Statistical analysis was performed to test the independent association between the demographic data, laboratory tests, and non-invasive liver fibrosis scores in subjects with different subgroups of MAFLD. Results: A total of 4869 subjects were identified in the NHANES 2017-2018, of which 1032 (21.2%) subjects were diagnosed with CKD. There was a higher prevalence of CKD in MAFLD subjects than in non-MALFD subjects (22.2% vs 19.1, p=0.048). After 1:1 propensity score matching by gender, age and race, we enrolled 1983 subjects with MAFLD diagnosed based on liver ultrasound transient elastography and 1983 PS-matched subjects without MAFLD. MAFLD was not independently associated with CKD after PSM. Further investigation showed that age (OR: 1.05, 95% CI: 1.03 similar to 1.05, p<0.001), hypertension (OR: 1.66, 95% CI: 1.38 similar to 2.00, p<0.001), DM (OR: 2.21, 95% CI: 1.89 similar to 3.11, p<0.001), hyperuricemia (OR: 1.91, 95% CI: 1.55 similar to 2.36, p<0.001), ALP (OR: 1.00, 95% CI: 1.00 similar to 1.01, p=0.010), and FIB-4 score (OR: 1.23, 95% CI: 1.05 similar to 1.01, p=0.011) were independently associated with CKD. In the subgroup analysis, the subgroups of MAFLD complicated with DM, age, hypertension, and hyperuricemia were independently related to the incidence of CKD. In the subgroup of DM without MAFLD, age, hyperuricemia, ALP, and NFS score were independently related to the incidence of CKD. In the subgroup of MAFLD without DM, age, hypertension, hyperuricemia, and ALP were independently related to the incidence of CKD. Conclusion: Based on the NHANES 2017-2018, MAFLD was not independently associated with CKD. Thus, the link between MAFLD and CKD may be mediated by metabolic abnormalities, such as diabetes mellitus and hyperuricemia.