Association between fatty liver index and risk of end-stage renal disease stratified by kidney function in patients with type 2 diabetes: A nationwide population-based study

• Published in: Diabetes & metabolism 2023-07, Vol.49 (4), p.101454-101454, Article 101454
• Main Authors: Chung, Goh Eun, Han, Kyungdo, Lee, Kyu-Na, Bae, Jung Ho, Yang, Sun Young, Choi, Su-Yeon, Yim, Jeong Yoon, Heo, Nam Ju
• Format: Article
• Language: English
• Subjects: Chronic kidney disease; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; End-stage renal disease; Female; Glomerular Filtration Rate; Hepatic steatosis; Humans; Kidney; Kidney Failure, Chronic - epidemiology; Male; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - epidemiology; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - epidemiology; Risk Factors; Type 2 diabetes
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2023.101454

The effects of nonalcoholic fatty liver disease on the risk of end-stage renal disease (ESRD) remain unclear. We investigated the association between the fatty liver index (FLI) and risk of ESRD in patients with type 2 diabetes. This population‐based observational cohort study enrolled patients with diabetes who underwent health screening between 2009 and 2012 and utilized data from the Korean National Health Insurance Services. The FLI functioned as a surrogate marker for the presence of hepatic steatosis. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m² calculated using the Modification of Diet in Renal Disease equation. We performed Cox proportional hazards regression. Incident ESRD developed in 19,476 of 1,900,598 patients with type 2 diabetes during a median follow-up of 7.2 years. After adjusting for conventional risk factors, patients with high FLI scores had a higher risk for ESRD: FLI, 30–59 [hazard ratio (HR) = 1.124; 95% confidence interval (CI), 1.083–1.166]; FLI ≥ 60 [HR = 1.278; 95% CI, 1.217–1.343] compared with those with FLI < 30. The association between a high FLI score (≥ 60) and incident ESRD was more prominent in women than in men (male, FLI ≥60: HR, 1.106; 95% CI = 1.041–1.176 and female, FLI ≥ 60: HR, 1.835; 95% CI = 1.689–1.995). The association between a high FLI score (≥ 60) and the risk of ESRD differed according to baseline kidney function. High FLI scores increased the risk of ESRD (HR = 1.268; 95% CI, 1.198–1.342) in patients with CKD at baseline. High FLI scores are associated with a greater risk of ESRD in patients with type 2 diabetes with CKD at baseline. Close monitoring and appropriate management of hepatic steatosis may aid in preventing the progression of kidney dysfunction in patients with type 2 diabetes and CKD.