The association between nonalcoholic fatty liver disease (NAFLD) and renal function changes remains inconclusive. We explored whether the histological severity of NAFLD is associated with early deterioration of renal function.
Patients with biopsy-proven NAFLD were prospectively followed for renal function monitoring. A renal outcome was defined as a ≥ 50% increase in serum creatinine, a < 30% decrease in the estimated glomerular filtration rate (eGFR) or an eGFR < 45 mL/min/1.73 m2.
Among 455 NAFLD patients, 221 (48.6%) had nonalcoholic steatohepatitis (NASH), and no difference in baseline eGFR was found between NASH and NAFL patients. During a median follow-up of 32 months, a renal outcome occurred in 15 patients; the incidence rate was 12.3 per 1,000 person-years. Compared with NAFL, NASH did not increase the risk of renal outcomes. Among the histological components of NAFLD, lobular inflammation (≥ 2), fibrosis (≥ F3), and portal inflammation (≥ 3) significantly increased the risk of renal outcomes in the crude analysis (HR 3.35, 95% CI 1.10–9.11; HR 3.25, 95% CI 1.12–8.84; and HR 7.73, 95% CI 2.86–22.22). After adjustment for risk factors for renal dysfunction, including sex, age, diabetes, hypertension, and chronic kidney disease, only portal inflammation significantly increased the risk of renal outcomes (HR 5.88, 95% CI 1.87–18.42, p = 0.002).
Portal inflammation predicts early deterioration of renal function in patients with biopsy-proven NAFLD. Individualized monitoring of renal function based on the histological severity of NAFLD may be helpful for early identification of long-term renal outcomes.
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This study was supported by the National Research Foundation of Korea grant funded by the Korea Government (MEST) (2016R1D1A1B04934590) and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (HI17C0912). The funders played no role in the design of the study, collection, analysis, or interpretation of the data, preparation of the manuscript, or the decision to submit the article for publication.
Conflict of interest
Jung Nam An, Sae Kyung Joo, Bo Kyung Koo, Jung Ho Kim, Sohee Oh and Won Kim do not have any relevant conflict of interest or other financial disclosures.
This study was approved by the Institutional Review Board of Seoul National University Boramae Medical Center (16-2014-86) and was carried out in accordance with the guidelines of the 2013 Declaration of Helsinki. All study participants provided informed consent prior to recruitment into the registry.
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An, J.N., Joo, S.K., Koo, B.K. et al. Portal inflammation predicts renal dysfunction in patients with nonalcoholic fatty liver disease. Hepatol Int (2020). https://doi.org/10.1007/s12072-020-10063-9
- Nonalcoholic fatty liver disease
- Nonalcoholic steatohepatitis
- Portal inflammation
- Lobular inflammation
- Renal function
- Early deterioration
- Risk factors