Non-alcoholic fatty liver disease increases the risk of incident chronic kidney disease

United European Gastroenterol J. 2020 Oct;8(8):942-948. doi: 10.1177/2050640620944098. Epub 2020 Jul 23.


Background and aim: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease. Its role in the development of extrahepatic co-morbidities is under investigation. The impact of NAFLD on the development of chronic kidney disease (CKD) is incompletely understood. The aim of this study was to explore the potential contribution of NAFLD on CKD in Germany.

Methods: The Disease Analyzer Database covering 7.49 million cases in Germany was explored for patients diagnosed with NAFLD between 2000 and 2015 and was matched 1:1 to a cohort without NAFLD. Matching criteria included age, sex, physician, index year and co-diagnoses associated with CKD. The primary outcomes of this study were incidences of CKD and end-stage renal disease.

Results: A total of 48,057 patients with NAFLD were matched to 48,057 patients without NAFLD. Within 10 years of the index date, 17.1% of patients with NAFLD and 11.6% of patients without NAFLD were diagnosed with CKD (p < 0.001). On Cox regression analysis, NAFLD was significantly associated with the incidence of CKD (hazard ratio (HR) = 1.58, p < 0.001). This association remained significant across different age groups and subgroups such as patients with diabetes mellitus or arterial hypertension. There was no association between NAFLD and emerging dialysis therapy (HR = 1.25, p = 0.245).

Conclusions: In this large database analysis in Germany, NAFLD constitutes an independent risk factor for CKD. Patients living with NAFLD should be monitored for a change in kidney function, facilitating therapeutic measures for kidney disease at an early stage.

Keywords: NAFLD; NASH; anxiety disorder; depression; metabolic inflammation; metabolic syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Comorbidity
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / epidemiology*
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / epidemiology*
  • Retrospective Studies
  • Risk Factors