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Metabolic-associated fatty liver disease increases the risk of end-stage renal disease in patients with biopsy-confirmed diabetic nephropathy: a propensity-matched cohort study

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Abstract

Aims

To investigate the relationship between metabolic-associated fatty liver disease (MAFLD) and end-stage renal disease (ESRD) in patients with biopsy-confirmed diabetic nephropathy (DN).

Methods

A total of 316 participants with biopsy-confirmed DN between January 2008 and December 2019 were retrospectively assessed. Kaplan–Meier curve and Cox proportional hazard models were used to compare the risk of incident ESRD in 50 patients with MAFLD and 50 patients without MAFLD, after using propensity score matching (PSM) to address the imbalances of sex, age, baseline-estimated glomerular filtration rate, serum albumin, 24-h urine protein, hemoglobin and systolic blood pressure.

Results

During the median follow-up period of 3 years, there were 19 ESRD outcome events (19%) in PSM cohort. Kaplan–Meier curve analysis suggested that renal survival significantly deteriorated in patients with MAFLD versus those without MAFLD (p = 0.021). Additionally, the hazard ratios (95% confidence interval) of MAFLD were 3.12 (1.09–8.95, p = 0.035), 3.36 (1.09–10.43, p = 0.036), 3.66 (1.22–10.98, p = 0.021), 4.25 (1.34–13.45, p = 0.014), 3.11 (1.08–8.96, p = 0.035) and 5.84 (1.94–18.5, p = 0.003) after adjustment for six models, including demographic, clinical and pathological characteristics as well as medication use at the time of renal biopsy, respectively. Besides, patients with higher liver fibrosis score had a greater possibility of ESRD, comparing to those with lower liver fibrosis score (p = 0.002).

Conclusions

MAFLD increases the risk of incident ESRD in patients with biopsy-proven DN. Further research is needed to determine whether treatment targeting MAFLD improves the prognosis of DN.

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Data and material availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

This study was supported by the project of the National Natural Science Foundation of China (81970626). The funding source played no role in study design, data analysis, and manuscript writing or submission.

Author information

Authors and Affiliations

  1. Department of Nephrology, Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Yutong Zou, Lijun Zhao, Junlin Zhang, Yiting Wang, Yucheng Wu, Honghong Ren, Tingli Wang, Yuancheng Zhao & Fang Liu

  2. Division of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Huan Xu & Lin Li

  3. Division of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Nanwei Tong

  4. Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Nanwei Tong

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  1. Yutong Zou
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Correspondence to Nanwei Tong or Fang Liu.

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The study protocol was approved by the Institutional Review Board at the West China Hospital of Sichuan University [number 2013R01], and written informed consent was obtained from all participants.

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Zou, Y., Zhao, L., Zhang, J. et al. Metabolic-associated fatty liver disease increases the risk of end-stage renal disease in patients with biopsy-confirmed diabetic nephropathy: a propensity-matched cohort study. Acta Diabetol 60, 225–233 (2023). https://doi.org/10.1007/s00592-022-01978-w

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