| Abstract: | CONTEXT: Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease, associated with fibrosis and an increased risk of type 2 diabetes (T2DM) and chronic kidney disease (CKD). OBJECTIVE: To investigate the association of NAFLD fibrosis with development of CKD in aged patients with T2DM. DESIGN AND PATIENTS: This cross-sectional study enrolled 13915 participants. A further 1734 subjects who had been followed annually for 5 years comprised the retrospective cohort study. Non-invasive markers, NAFLD fibrosis score (NFS) and fibrosis index based on 4 factor (FIB-4) index, were applied to determine NAFLD fibrosis risk. RESULTS: In the cross-sectional study, there was an additive interaction for NAFLD with increased risk of fibrosis and T2DM on CKD incidence. Logistic regression demonstrated that as NAFLD fibrosis risk progressed from low to intermediate and high, there was a stepwise increase in CKD in patients with NAFLD, T2DM and those with co-existent NAFLD and T2DM when stratified by diabetes and fibrosis stage. FIB-4 had a much higher OR value than NFS for prediction of CKD incidence. In the cohort study, subjects were grouped according to FIB-4 and NFS. Cox regression analysis showed that FIB-4 intermediate risk (HR 1.268, 95% CI 1.056 - 1.521) and high risk (HR 2.516, 95% CI 1.970 - 3.214) were significant predictors of CKD progression. When NFS was applied, only high risk was a significant predictor. CONCLUSIONS: NAFLD with an increased risk of fibrosis and presence of T2DM had an additive interaction on CKD incidence. Increased risk of NAFLD fibrosis was closely associated with CKD incidence and progression in aged T2DM patients. FIB-4 outperformed NFS as a non-invasive means to predict CKD development. |
