The fatty liver index as a predictor of incident chronic kidney disease in a 10-year prospective cohort study

PLoS One. 2017 Jul 24;12(7):e0180951. doi: 10.1371/journal.pone.0180951. eCollection 2017.

Abstract

Background: Although non-alcoholic fatty liver disease (NAFLD) is considered to be associated with chronic kidney disease (CKD), long-term follow up data is lacking. We investigated whether NAFLD, as determined by the fatty liver index (FLI), could predict incident CKD in 10-year prospective cohort study. We also assessed the clinical utility of FLI to predict the development of CKD.

Methods: 6,238 adults aged 40 to 69 years without baseline CKD from the Ansan-Ansung cohort were examined. Patients were classified according to FLI as follows: FLI<30, no NAFLD; FLI≥60, NAFLD; and 30≤ FLI<60, intermediate. Incident CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. The clinical utility of FLI in predicting incident CKD was estimated via area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses.

Results: During an average of 10 years of follow-up, 724 subjects (15.21%) developed CKD. The adjusted hazard ratio [95% confidence interval (CI)] for incident CKD increased in a graded manner with FLI increased (<30 vs. 30-59 vs. ≥60 = 1 vs. 1.17 [0.997-1.375] vs. 1.459 [1.189-1.791], respectively, P for trend = 0.0012). Incorporation of FLI into traditional risk factors of CKD significantly increased prediction of incident CKD based on NRI (17%; 95% CI, 8.9-25%; P-value <0.001) and IDI (0.002; 95% CI, 0.0046-0.0143; P-value = 0.046).

Conclusions: FLI, a surrogate marker of NAFLD, was an independent risk factor for incident CKD. FLI provides meaningful incremental risk reclassification beyond that of conventional risk factors of CKD.

MeSH terms

  • Biomarkers / metabolism
  • Female
  • Glomerular Filtration Rate / physiology
  • Humans
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / complications*
  • Non-alcoholic Fatty Liver Disease / metabolism
  • Non-alcoholic Fatty Liver Disease / physiopathology*
  • Proportional Hazards Models
  • Prospective Studies
  • ROC Curve
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / metabolism
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Factors

Substances

  • Biomarkers

Grants and funding

This study was supported in part by grants of the Korea Centers for Disease Control and Prevention (2005-E71013-00, 2006-E71002-00, 2007-E71013-00, 2008-E71004-00, 2009-E71006-00, 2010-E71003-00) and Gangwon branch of Korean Endocrine Society. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.