代谢功能障碍相关性脂肪性肝病（SLD）和酒精相关性肝病，而非代谢功能障碍相关性脂肪性肝病，与十年随访期间新发慢性肾病有独立关联。

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Research Pub Date : 2024-08-07 DOI:10.1111/hepr.14097

Kazuma Mori, Marenao Tanaka, Tatsuya Sato, Yukinori Akiyama, Keisuke Endo, Toshifumi Ogawa, Toru Suzuki, Hiroki Aida, Wataru Kawaharata, Kei Nakata, Itaru Hosaka, Araya Umetsu, Nagisa Hanawa, Masato Furuhashi

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引用次数: 0

摘要

目的：最近提出了新的脂肪性肝病（SLD）命名法，包括代谢功能障碍相关SLD（MASLD）、代谢功能障碍和酒精摄入增加（MetALD）以及酒精相关肝病（ALD）。我们的目的是阐明各类 SLD 与慢性肾脏病（CKD）之间的关系：我们对 12 138 名日本受试者（男性/女性，7984/4154；平均年龄 48 岁）进行了为期 10 年的调查，这些受试者每年都接受包括腹部超声波检查在内的健康检查，我们调查了各种 SLD 对 CKD 发展的影响，CKD 的定义是估计肾小球滤过率（eGFR）2 或尿蛋白阳性：结果：无代谢功能障碍的 SLD（SLD-MD[-]）、MASLD、MetALD 和 ALD 的发病率分别为 1.7%、26.3%、4.9% 和 1.9%。在随访期间，1963 名受试者（16.2%）（男性/女性，1374 [17.2%]/589 [14.2%]）出现了新的慢性肾功能衰竭。在对年龄、性别、eGFR、当前吸烟习惯、糖尿病、高血压和血脂异常进行调整后，多变量 Cox 比例危险模型分析显示，MASLD 受试者发生 CKD 的危险比（HR [95% 置信区间]）（1.20 [1.08-1.33]，p = 0.001）和 ALD（1.41 [1.05-1.88]，p = 0.022）受试者，但 MetALD（1.11 [0.90-1.36]，p = 0.332）受试者发生 CKD 的危险比（HR）显著高于非 SLD 受试者。有趣的是，SLD-MD[-]受试者的 HR（0.61 [0.39-0.96]，p = 0.034）明显低于非 SLD 受试者。在CKD发病的传统风险因素中加入新的SLD分类，可显著提高判别能力：结论：MASLD 和 ALD（而非 SLD-MD[-]）与 CKD 的发生有独立的相关性。

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Metabolic dysfunction-associated steatotic liver disease (SLD) and alcohol-associated liver disease, but not SLD without metabolic dysfunction, are independently associated with new onset of chronic kidney disease during a 10-year follow-up period.

Aims: The new nomenclature of steatotic liver disease (SLD) including metabolic dysfunction-associated SLD (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD) has recently been proposed. We aimed to elucidate the relationship between each category of SLD and chronic kidney disease (CKD).

Methods: We investigated the effects of various SLDs on the development of CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² or positive for urinary protein, during a 10-year period in 12 138 Japanese subjects (men / women, 7984/4154; mean age, 48 years) who received annual health examinations including abdominal ultrasonography.

Results: The prevalences of SLD without metabolic dysfunction (SLD-MD[-]), MASLD, MetALD, and ALD were 1.7%, 26.3%, 4.9%, and 1.9%, respectively. During the follow-up period, 1963 subjects (16.2%) (men / women, 1374 [17.2%]/589 [14.2%]) had new onset of CKD. Multivariable Cox proportional hazard model analyses after adjustment of age, sex, eGFR, current smoking habit, diabetes mellitus, hypertension, and dyslipidemia showed that the hazard ratios (HR [95% confidence interval]) for the development of CKD in subjects with MASLD (1.20 [1.08-1.33], p = 0.001) and those with ALD (1.41 [1.05-1.88], p = 0.022), but not those with MetALD (1.11 [0.90-1.36], p = 0.332), were significantly higher than the HR in subjects with non-SLD. Interestingly, subjects with SLD-MD[-] had a significantly lower HR (0.61 [0.39-0.96], p = 0.034) than that in subjects with non-SLD. The addition of the novel classification of SLDs into traditional risk factors for the development of CKD significantly improved the discriminatory capacity.

Conclusions: MASLD and ALD, but not SLD-MD[-], are independently associated with the development of CKD.

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来源期刊

Hepatology Research 医学-胃肠肝病学

CiteScore

8.30

自引率

14.30%

发文量

124

审稿时长

1 months

期刊介绍： Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.