The Role of Metabolic Dysfunction–Associated Fatty Liver Disease in Developing Chronic Kidney Disease: Longitudinal Cohort Study

BACKGROUND: The association between metabolic dysfunction–associated fatty liver disease (MAFLD) and chronic kidney disease (CKD) is unclear. OBJECTIVE: This longitudinal cohort study aimed to test whether MAFLD plays an important role in the development of CKD. METHODS: This cohort study included 41,246 participants who had undergone 3 or more health examinations from 2008 to 2015 at the People’s Hospital of Guangxi Zhuang Autonomous Region, China. Participants were categorized into 2 groups according to whether they presented with or without MAFLD. The occurrence of new-onset CKD was stated as either an estimated glomerular filtration rate of <60 mL/min per 1.73 m(2) or a higher level of albuminuria during their follow-up appointment. The association between MAFLD and CKD was evaluated using a Cox regression method. RESULTS: Of the 41,246 participants, 11,860 (28.8%) were diagnosed with MAFLD. Over the course of the 14-year follow-up (median 10.0 years), 5347 (13%) participants experienced a new incident of CKD (135.73 per 10,000 person-years). MAFLD was discovered as an important risk factor for new incidents of CKD (hazard ratio 1.18, 95% CI 1.11-1.26) by using the multivariable Cox proportional hazard regression model. When stratified by gender, the adjusted hazard ratio for the incidence of CKD in men and women with MAFLD were 1.16 (95% CI 1.07-1.26) and 1.32 (95% CI 1.18-1.48), respectively. According to the subgroup analysis results, after adjusting for confounding factors, the MAFLD-related CKD risk was greater in men aged <60 years (P(interaction)=.001) and in those with combined dyslipidemia (P(interaction)=.02), but this relationship was not found in women (all P(interaction)>.05). CONCLUSIONS: MAFLD plays an important role in the development of new incidents of CKD in the long run. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200058543; https://www.chictr.org.cn/showproj.html?proj=153109