Association Between Liver Fibrosis Score and Diabetic Kidney Disease: A Retrospective Cross-Sectional Study of Hospitalized Patients

Abstract

Objectives To investigate the association between liver fibrosis score and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM).

Methods A total of 897 hospitalized patients with T2DM were included in this study. Each patient completed DKD screening. Logistic regression analysis was used to assess the predictive value of non-alcoholic fatty liver disease fibrosis score (NAFLD-FS) and fibrosis-4 (FIB-4) for the occurrence of DKD and risk for DKD progression, respectively.

Results The prevalence of DKD and risk for its progression significantly increased with increasing NAFLD-FS risk category. DKD prevalence also increased with increasing FIB-4 risk category. Multivariate logistic regression analysis showed that the “high-risk” NAFLD-FS had a significantly higher risk of DKD (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.16–3.08) and risk for DKD progression (OR: 2.88, 95% CI: 1.23–6.78), and the “intermediate-risk” FIB-4 had a significantly higher risk of DKD (OR: 1.41, 95% CI: 1.00–1.98). Subgroup analysis showed that the association between NAFLD-FS and FIB-4 and DKD was significant in the female subgroup, whereas the association between the “high-risk” NAFLD-FS and risk for DKD progression was significant in the male subgroup.

Conclusions NAFLD-FS and FIB-4 are strongly associated with DKD and risk for DKD progression in patients with T2DM. Additionally, sexual dimorphism exists in this association.

Keywords

non-alcoholic fatty liver disease fibrosis score - fibrosis-4 - diabetic kidney disease - type 2 diabetes mellitus

^‡ These authors contributed equally to this work: Jie Zhang, Shen Chen

Publication History

Received: 15 November 2023
Received: 24 February 2024

Accepted: 28 February 2024

Article published online:
10 April 2024

• References

• 1 Sabanayagam C, Chee ML, Banu R. et al. Association of diabetic retinopathy and diabetic kidney disease with all-cause and cardiovascular mortality in a multiethnic Asian population. JAMA Netw Open 2019; 2: e191540
• 2 Ren J, Liu D, Li G. et al. Prediction and risk stratification of cardiovascular disease in diabetic kidney disease patients. Front Cardiovasc Med 2022; 9: 923549
• 3 Bansal N. Evolution of cardiovascular disease during the transition to end-stage renal disease. Semin Nephrol 2017; 37: 120-131
• 4 Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: Effects on the cardiovascular system. Circulation 2007; 116: 85-97
• 5 Xu J, Shi X, Pan Y. The association of aspartate aminotransferase/alanine aminotransferase ratio with diabetic nephropathy in patients with type 2 diabetes. Diabetes Metab Syndr Obes 2021; 14: 3831-3837
• 6 Wu Y, Liu F. Aspartate aminotransferase to alanine aminotransferase ratio and the risk of diabetic nephropathy progression in patients with type 2 diabetes mellitus: A biopsy-based study. J Diabetes Complications 2022; 36: 108235
• 7 Targher G, Byrne CD. Non-alcoholic fatty liver disease: An emerging driving force in chronic kidney disease. Nat Rev Nephrol 2017; 13: 297-310
• 8 Chalasani N, Younossi Z, Lavine JE. et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology . 2012; 142: 1592-1609
• 9 Angulo P, Bugianesi E, Bjornsson ES. et al. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2013; 145: 782-789
• 10 Xiao G, Zhu S, Xiao X. et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology 2017; 66: 1486-1501
• 11 Wen X, Zhou X, Chen D. et al. Association between non-alcoholic fatty liver disease and diabetes-related microvascular complications: A retrospective cross-sectional study of hospitalized patients. Endocr Pract 2022; 28: 304-309
• 12 Sun Y, Hong L, Huang Z. et al. Fibrosis risk in nonalcoholic fatty liver disease is related to chronic kidney disease in older type 2 diabetes patients. J Clin Endocrinol Metab 2022; 107: e3661-e3669
• 13 Levey AS, Stevens LA, Schmid CH. et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-612
• 14 Stevens PE, Levin A. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158: 825-830
• 15 McPherson S, Hardy T, Dufour JF. et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol 2017; 112: 740-751
• 16 Targher G, Lonardo A, Byrne CD. Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus. Nat Rev Endocrinol 2018; 14: 99-114
• 17 Morikawa H, Mano K, Horinaka H. et al. Development of non-invasive method for assessment of hepatic steatosis. Ultrasonics 2016; 72: 195-200
• 18 Jin JL, Zhang HW, Cao YX. et al. Liver fibrosis scores and coronary atherosclerosis: Novel findings in patients with stable coronary artery disease. Hepatol Int 2021; 15: 413-423
• 19 Hagstrom H, Talback M, Andreasson A. et al. Ability of noninvasive scoring systems to identify individuals in the population at risk for severe liver disease. Gastroenterology 2020; 158: 200-214
• 20 Kuma A, Mafune K, Uchino B. et al. Potential link between high FIB-4 score and chronic kidney disease in metabolically healthy men. Sci Rep 2022; 12: 16638
• 21 Xu HW, Hsu YC, Chang CH. et al. High FIB-4 index as an independent risk factor of prevalent chronic kidney disease in patients with nonalcoholic fatty liver disease. Hepatol Int 2016; 10: 340-346
• 22 Piani F, Melena I, Tommerdahl KL. et al. Sex-related differences in diabetic kidney disease: A review on the mechanisms and potential therapeutic implications. J Diabetes Complications 2021; 35: 107841
• 23 Byrne CD, Targher G. NAFLD as a driver of chronic kidney disease. J Hepatol 2020; 72: 785-801
• 24 Kotoku K, Michishita R, Matsuda T. et al. The association between decreased kidney function and FIB-4 Index value, as indirect liver fibrosis indicator, in middle-aged and older subjects. Int J Environ Res Public Health 2021; 18: 6980
• 25 Musso G, De Michieli F, Bongiovanni D. et al. New pharmacologic agents that target inflammation and fibrosis in nonalcoholic steatohepatitis-related kidney disease. Clin Gastroenterol Hepatol 2017; 15: 972-985
• 26 Siragy HM, Carey RM. Role of the intrarenal renin-angiotensin-aldosterone system in chronic kidney disease. Am J Nephrol 2010; 31: 541-550
• 27 Marcuccilli M, Chonchol M. NAFLD and chronic kidney disease. Int J Mol Sci 2016; 17: 562