Renal Dysfunction in Patients With Nonalcoholic Fatty Liver Disease is Related to the Presence of Diabetes Mellitus and Severity of Liver Disease

Overview

Journal J Clin Exp Hepatol

Publisher Elsevier

Specialty Gastroenterology

Date 2019 Feb 16

PMID 30765935

Citations 14

Authors

Ram V Nampoothiri

Ajay Duseja

Manish Rathi

Swastik Agrawal

Naresh Sachdeva

Manu Mehta

Harpal S Dhaliwal

Radha K Dhiman

Yogesh Chawla

Affiliations

Soon will be listed here.

Abstract

Background And Aims: There is sparse data on the prevalence of renal dysfunction in patients with nonalcoholic fatty liver disease (NAFLD). The aim of the present study was to evaluate the presence of renal dysfunction in patients with NAFLD and correlate it with the severity of liver disease.

Methods: One hundred nonalcoholic patients with ultrasound showing hepatic steatosis were enrolled into the study after exclusion of other causes. Presence of renal dysfunction was estimated by glomerular filtration rate and by evaluating 24 h urinary protein and microalbumin. Various risk factors including components of metabolic syndrome, severity of hepatic steatosis (as assessed on ultrasound), hepatic necro-inflammation (as assessed by hepatic transaminases) and hepatic fibrosis (as assessed by transient elastography) were correlated with the presence of renal dysfunction.

Results: Twenty eight (28%) patients with NAFLD had evidence of impaired renal function with 5 (5%) having abnormal glomerular filtration rate, 18 (18%) having significant proteinuria and 5 (5%) having both. Presence of type 2 diabetes mellitus, raised hepatic transaminases and advanced fibrosis on transient elastography were found as independent predictors of impaired renal function with raised hepatic transaminases having the best sensitivity (89%) and presence of advanced fibrosis the best specificity (90%). A model comprising of these three parameters had good accuracy (AUROC = 0.763) in predicting impaired renal function in patients with NAFLD.

Conclusions: Around one-third of patients with NAFLD have impaired renal functions. Prevalence of impaired renal function in patients with NAFLD is dependent on the severity of liver disease and presence of diabetes mellitus.

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References

. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001; 285(19):2486-97. DOI: 10.1001/jama.285.19.2486. View

Chitturi S, Abeygunasekera S, Farrell G, Holmes-Walker J, Hui J, Fung C . NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002; 35(2):373-9. DOI: 10.1053/jhep.2002.30692. View

. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 Suppl 1):S1-266. View

Choo V . WHO reassesses appropriate body-mass index for Asian populations. Lancet. 2002; 360(9328):235. DOI: 10.1016/S0140-6736(02)09512-0. View

Cockcroft D, GAULT M . Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16(1):31-41. DOI: 10.1159/000180580. View

Levey A, Coresh J, Balk E, Kausz A, Levin A, Steffes M . National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003; 139(2):137-47. DOI: 10.7326/0003-4819-139-2-200307150-00013. View

Chen J, Muntner P, Hamm L, Jones D, Batuman V, Fonseca V . The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med. 2004; 140(3):167-74. DOI: 10.7326/0003-4819-140-3-200402030-00007. View

Duseja A, Nanda M, Das A, Das R, Bhansali A, Chawla Y . Prevalence of obesity, diabetes mellitus and hyperlipidaemia in patients with cryptogenic liver cirrhosis. Trop Gastroenterol. 2004; 25(1):15-7. View

Barai S, Bandopadhayaya G, Patel C, Rathi M, Kumar R, Bhowmik D . Do healthy potential kidney donors in india have an average glomerular filtration rate of 81.4 ml/min?. Nephron Physiol. 2005; 101(1):p21-6. DOI: 10.1159/000086038. View

10.

Mahajan S, Mukhiya G, Singh R, Tiwari S, Kalra V, Bhowmik D . Assessing glomerular filtration rate in healthy Indian adults: a comparison of various prediction equations. J Nephrol. 2005; 18(3):257-61. View

11.

Grundy S, Cleeman J, Daniels S, Donato K, Eckel R, Franklin B . Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112(17):2735-52. DOI: 10.1161/CIRCULATIONAHA.105.169404. View

12.

Farrell G, Larter C . Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006; 43(2 Suppl 1):S99-S112. DOI: 10.1002/hep.20973. View

13.

Madan K, Batra Y, Gupta S, Chander B, Anand Rajan K, Tewatia M . Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians. World J Gastroenterol. 2006; 12(21):3400-5. PMC: 4087872. DOI: 10.3748/wjg.v12.i21.3400. View

14.

Duseja A, Das A, Das R, Dhiman R, Chawla Y, Bhansali A . The clinicopathological profile of Indian patients with nonalcoholic fatty liver disease (NAFLD) is different from that in the West. Dig Dis Sci. 2007; 52(9):2368-74. DOI: 10.1007/s10620-006-9136-y. View

15.

Barai S, Gambhir S, Prasad N, Sharma R, Ora M, Kumar A . Levels of GFR and protein-induced hyperfiltration in kidney donors: a single-center experience in India. Am J Kidney Dis. 2008; 51(3):407-14. DOI: 10.1053/j.ajkd.2007.11.008. View

16.

Chang Y, Ryu S, Sung E, Woo H, Oh E, Cha K . Nonalcoholic fatty liver disease predicts chronic kidney disease in nonhypertensive and nondiabetic Korean men. Metabolism. 2008; 57(4):569-76. DOI: 10.1016/j.metabol.2007.11.022. View

17.

Targher G, Chonchol M, Bertolini L, Rodella S, Zenari L, Lippi G . Increased risk of CKD among type 2 diabetics with nonalcoholic fatty liver disease. J Am Soc Nephrol. 2008; 19(8):1564-70. PMC: 2488256. DOI: 10.1681/ASN.2007101155. View

18.

Campos G, Bambha K, Vittinghoff E, Rabl C, Posselt A, Ciovica R . A clinical scoring system for predicting nonalcoholic steatohepatitis in morbidly obese patients. Hepatology. 2008; 47(6):1916-23. DOI: 10.1002/hep.22241. View

19.

Hwang S, Cho Y, Yun J, Park J, Kim H, Park D . Impact of non-alcoholic fatty liver disease on microalbuminuria in patients with prediabetes and diabetes. Intern Med J. 2009; 40(6):437-42. DOI: 10.1111/j.1445-5994.2009.01979.x. View

20.

Yilmaz Y, Ozen Alahdab Y, Yonal O, Kurt R, Kedrah A, Ataizi Celikel C . Microalbuminuria in nondiabetic patients with nonalcoholic fatty liver disease: association with liver fibrosis. Metabolism. 2010; 59(9):1327-30. DOI: 10.1016/j.metabol.2009.12.012. View