Objective

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

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2 型糖尿病患者脂肪肝指数与按肾功能分层的终末期肾病风险之间的关联：一项全国性人群研究

客观的

非酒精性脂肪肝对终末期肾病（ESRD）风险的影响仍不清楚。我们调查了 2 型糖尿病患者的脂肪肝指数 (FLI) 与 ESRD 风险之间的关联。

方法

这项基于人群的观察性队列研究纳入了 2009 年至 2012 年间接受健康筛查的糖尿病患者，并利用了韩国国民健康保险服务的数据。FLI 充当肝脂肪变性存在的替代标记。慢性肾病 (CKD) 的定义是使用肾病饮食修改方程计算得出的估计肾小球滤过率 < 60 ml/min/1.73 m²。我们进行了 Cox 比例风险回归。

结果

在中位随访 7.2 年期间，1,900,598 名 2 型糖尿病患者中的 19,476 名发生了 ESRD。调整常规危险因素后，FLI 评分高的患者发生 ESRD 的风险较高：FLI，30-59 [风险比 (HR) = 1.124；95% 置信区间 (CI), 1.083–1.166]; FLI ≥ 60 [HR = 1.278；95% CI, 1.217–1.343] 与 FLI < 30 的患者相比。高 FLI 评分 (≥ 60) 与 ESRD 事件之间的关联在女性中比男性更显着（男性，FLI ≥ 60：HR，1.106；95） % CI = 1.041–1.176，女性，FLI ≥ 60：HR，1.835；95% CI = 1.689–1.995）。高 FLI 评分（≥ 60）与 ESRD 风险之间的关联因基线肾功能而异。高 FLI 评分会增加基线 CKD 患者的 ESRD 风险（HR = 1.268；95% CI，1.198–1.342）。

结论

高 FLI 评分与基线时患有 CKD 的 2 型糖尿病患者患 ESRD 的风险较高相关。密切监测和适当管理肝脂肪变性可能有助于预防 2 型糖尿病和 CKD 患者肾功能障碍的进展。