Development of chronic kidney disease in patients with non-alcoholic fatty liver disease: A cohort study

Dong Hyun Sinn, Danbee Kang, Hye Ryoun Jang, Seonhye Gu, Soo Jin Cho, Seung Woon Paik, Seungho Ryu, Yoosoo Chang, Mariana Lazo, Eliseo Guallar, Juhee Cho, Geum Youn Gwak

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56 Scopus citations


Background & Aims Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9 y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60 ml/min/1.73 m2. During 200,790 person-years of follow-up (median follow-up of 4.15 years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04–1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS <−1.455 and those with NFS ≥−1.455 to participants without NAFLD were 1.09 (95% CI 0.91–1.32) and 1.58 (95% CI 1.30–1.92), respectively. The association was consistent across clinically relevant subgroups. Conclusion In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD. Lay summary The presence of fatty liver is associated with the future decline of renal function. Thus, fatty liver patients need to be monitored regularly for renal function.

Original languageEnglish (US)
Pages (from-to)1274-1280
Number of pages7
JournalJournal of Hepatology
Issue number6
StatePublished - Dec 2017


  • Chronic kidney disease
  • Cohort
  • Fatty liver
  • Liver fibrosis

ASJC Scopus subject areas

  • Hepatology


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