Nonalcoholic Fatty Liver Disease and Renal Function Impairment: A Cross-Sectional Population-Based Study on Its Relationship From 1999 to 2016
Nonalcoholic Fatty Liver Disease and Renal Function Impairment: A Cross-Sectional Population-Based Study on Its Relationship From 1999 to 2016
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DOI：
10.1002/hep4.1408
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发表时间：
2019-10-01
影响因子：
5.1
通讯作者：
Nguyen, Mindie H.
中科院分区：
文献类型：
--
作者：
Le, Michael H.;Yeo, Yee Hui;Nguyen, Mindie H.
越来越多的证据表明非酒精性脂肪肝（NAFLD）与肾功能损害有关。因此，我们旨在证明NAFLD、NAFLD伴肾功能不全（RI）、疾病知晓率和死亡率随时间的趋势。患者数据摘自1999-2016年国家健康和营养检查调查（NHANES）。共有14，255名成年研究参与者没有竞争性肝病或大量饮酒，并具有完整的实验室数据。使用美国脂肪肝指数（USFLI）定义NAFLD，使用慢性肾脏病流行病学协作组方程和尿白蛋白：肌酐比值定义RI。死亡数据来自国家死亡指数（截至2015年12月31日）。参与者中NAFLD的患病率为31.2%（95%置信区间[CI]，30.01-32.46）;在这些参与者中，22.05%（95% CI，20.34-23.85）患有RI。从1999年到2016年，NAFLD无RI（P = 0.048）和NAFLD RI（P = 0.006）的患病率均显著增加。在NAFLD-RI患者中，肾脏疾病的知晓率为8.56%（95%CI，6.69-10.89），而所有NAFLD患者中肝脏疾病的知晓率为4.49%（95%CI，3.17-6.33）。在NAFLD患者中，重度RI患者的全因死亡率（104.4; 95% CI，83.65-130.39）和其他残留死亡原因（平均值，50.88; 95% CI，37.02-69.93）的每1,000人年死亡率最高。结论：在美国，NAFLD和NAFLD-RI的患病率在过去20年中有所增加。肾脏疾病和肝脏疾病的认知度低是主要的公共卫生问题，因为NAFLD-RI患者的死亡率明显高于仅NAFLD患者。
There is growing evidence that links nonalcoholic fatty liver disease (NAFLD) with impairment of renal function. As such, we aimed to demonstrate the trend of NAFLD, NAFLD with renal insufficiency (RI), disease awareness, and mortality over time. Patient data were extracted from the National Health and Nutrition Examination Survey (NHANES) 1999-2016. A total of 14,255 adult study participants without competing liver disease or heavy drinking and with complete laboratory data were included. NAFLD was defined using the U.S. Fatty Liver Index (USFLI) and RI was defined using the Chronic Kidney Disease Epidemiology Collaboration equation and urine albumin:creatinine ratio. Death data were obtained from the National Death Index (up to December 31, 2015). Prevalence of NAFLD in participants was 31.2% (95% confidence interval [CI], 30.01-32.46); of these participants, 22.05% (95% CI, 20.34-23.85) had RI. From 1999 to 2016, prevalence of both NAFLD without RI (P = 0.048) and NAFLD-RI (P = 0.006) increased significantly. Among those with NAFLD-RI, awareness of kidney disease was 8.56% (95% CI, 6.69-10.89), while awareness of liver disease among all NAFLD was 4.49% (95% CI, 3.17-6.33). Among those with NAFLD, mortality incidence per 1,000 person years was highest among those with severe RI in all-cause mortality (104.4; 95% CI, 83.65-130.39) and other residual causes of mortality (mean, 50.88; 95% CI, 37.02-69.93). Conclusion: Prevalence of NAFLD and NAFLD-RI has increased over the past 2 decades in the United States. Low kidney disease and liver disease awareness are major public health issues as those with NAFLD-RI have significantly higher mortality than those with only NAFLD.