FIB-4 Index and Diabetes Mellitus Are Associated with Chronic Kidney Disease in Japanese Patients with Non-Alcoholic Fatty Liver Disease

Int J Mol Sci. 2019 Dec 25;21(1):171. doi: 10.3390/ijms21010171.


Non-alcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). The aim of this retrospective study was to determine the risk factors for progression of CKD in patients with biopsy-proven NAFLD including patatin-like phospholipase domain containing 3 (PNPLA3) polymorphism. A total of 344 patients with biopsy-proven NAFLD were enrolled consecutively in this study. Multivariate analysis identified males (odds ratio (OR) 5.46), age (per 1 year, OR 1.07), and FIB-4 index (≥1.30, OR 3.85) as factors associated with CKD. Of the 154 patients with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min, 30 had a deterioration in CKD stage and 15 developed CKD after 3 years. Multivariate analysis identified diabetes mellitus (OR 2.44) as a risk factor for deterioration in CKD stage, while diabetes mellitus (OR 21.54) and baseline eGFR (per 1 mL/min OR 0.88) were risk factors for development of CKD. PNPLA3 did not affect the change in eGFR. In NAFLD patients, a high FIB-4 index was associated with CKD to increases in the index linked to reductions in eGFR. In order to prevent development of CKD, an appropriate therapy focusing on renal function is needed for NAFLD patients, especially those with diabetes.

Keywords: Hepatic fibrosis; PNPLA3; Type 2 diabetes; nonalcoholic fatty liver disease.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / pathology*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Japan / epidemiology
  • Lipase / genetics
  • Liver / metabolism
  • Liver / pathology
  • Male
  • Membrane Proteins / genetics
  • Middle Aged
  • Multivariate Analysis
  • Non-alcoholic Fatty Liver Disease / etiology
  • Non-alcoholic Fatty Liver Disease / pathology*
  • Odds Ratio
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / pathology*
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index*
  • Young Adult


  • Membrane Proteins
  • Lipase
  • adiponutrin, human