Acute kidney injury is associated with liver-related events in patients with metabolic dysfunction-associated fatty liver disease

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2025-03-16 DOI:10.1016/j.diabet.2025.101639

Caoxiang She , Zhixin Guo , Yaduan Lin , Shiyu Zhou , Mingzhen Pang , Jiao Liu , Lisha Cao , Licong Su , Yinfang Sun , Chuyao Fang , Xian Shao , Sheng Nie

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Abstract

Background

Evidence regarding the role of acute kidney injury (AKI) in long-term development of metabolic dysfunction-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the associations between AKI and liver-related events in patients with MAFLD.

Methods

This study involved 50,499 Chinese adults with MAFLD from the China Renal Data System (CRDS) database. We identified AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was a composite of liver-related mortality and major adverse liver outcomes. The secondary outcome was an escalation of fibrosis-4 (FIB-4) risk scores. Cox proportional hazard models were performed to assess the association between AKI and the study outcomes.

Results

The median age of the patients was 59.17 years, with 54.7% being male. There were 3,711 (7.3%) patients who experienced AKI during hospitalization. A total of 1,660 (3.3%) patients experienced composite liver outcome. Patients with AKI during hospitalization had higher risk of composite liver outcomes (adjusted hazard ratio (aHR) 1.83 [95% confidence interval 1.38;2.41] P < 0.001), especially among those with severe AKI (stage 2/3) (aHR 2.36 [1.57;3.54] P < 0.001). Regarding the secondary outcome, AKI was also associated with an increased risk of escalation of FIB-4 risk scores (aHR 1.28 [1.14;1.44] P < 0.001). These associations remained consistent across various subgroups and sensitivity analyses.

Conclusions

AKI was significantly associated with an increased risk of liver-related events among patients with MAFLD. These findings suggest that enhanced vigilance toward AKI may be justifiable in MAFLD patients.

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代谢功能障碍相关脂肪肝患者的急性肾损伤与肝脏相关事件相关

背景：关于急性肾损伤（AKI）在代谢功能障碍相关脂肪肝（MAFLD）长期发展中的作用的证据有限。我们的目的是调查AKI与MAFLD患者肝脏相关事件之间的关系。方法：本研究纳入来自中国肾脏数据系统（CRDS）数据库的50499名中国成年MAFLD患者。我们根据肾病改善全球结局（KDIGO）标准，使用患者水平的血清肌酐数据确定AKI。主要结局是肝脏相关死亡率和主要不良肝脏结局的综合。次要结局是纤维化-4 （FIB-4）风险评分升高。采用Cox比例风险模型评估AKI与研究结果之间的关系。结果：患者中位年龄为59.17岁，男性占54.7%。3711例（7.3%）患者在住院期间发生AKI。共有1660例（3.3%）患者出现了复合肝脏结局。住院期间发生AKI的患者发生复合肝脏结局的风险较高（校正危险比（aHR） 1.83[95%可信区间1.38;2.41]P < 0.001），尤其是重度AKI（2/3期）患者（aHR 2.36 [1.57;3.54] P < 0.001）。至于次要结局，AKI也与FIB-4风险评分升高的风险增加相关（aHR 1.28 [1.14;1.44] P < 0.001）。这些关联在不同的亚组和敏感性分析中保持一致。结论：AKI与MAFLD患者肝脏相关事件风险增加显著相关。这些发现表明，在MAFLD患者中提高对AKI的警惕性可能是合理的。

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.