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

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes & metabolism Pub Date : 2023-07-01 DOI:10.1016/j.diabet.2023.101454

Goh Eun Chung , Kyungdo Han , Kyu-Na Lee , Jung Ho Bae , Sun Young Yang , Su-Yeon Choi , Jeong Yoon Yim , Nam Ju Heo

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Abstract

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.

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脂肪肝指数与2型糖尿病患者肾功能分层终末期肾病风险之间的关系:一项基于全国人群的研究

目的非酒精性脂肪肝对终末期肾病（ESRD）风险的影响尚不清楚。我们研究了2型糖尿病患者脂肪肝指数（FLI）与ESRD风险之间的关系。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，并利用了韩国国家健康保险服务局的数据。FLI可作为肝脂肪变性的替代标志物。慢性肾脏疾病（CKD）被定义为估计的肾小球滤过率<；60 ml/min/1.73 m²，使用肾脏疾病饮食修正方程计算。我们进行了Cox比例风险回归。结果1900598例2型糖尿病患者中，19476例发生ESRD，中位随访时间为7.2年。在调整了传统风险因素后，FLI评分高的患者患ESRD的风险更高：FLI，30-59[风险比（HR）=1.124；95%置信区间（CI），1.083-1.16]；FLI≥60[HR=1.278；95%CI，1.217–1.343]与FLI<；30.高FLI评分（≥60）与ESRD发生率之间的相关性在女性中比在男性中更为突出（男性，FLI≥60:HR，1.106；95%CI=1.041–1.176，女性，FLI≤60:HR为1.835；95%CI=1.689–1.995）。基线时，高FLI评分会增加CKD患者患ESRD的风险（HR=1.268；95%CI，1.198-1.342）。结论在基线时，高FLI评分与2型糖尿病合并CKD患者发生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。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.