Investigating the Association between Steatotic Liver Disease and CKD in a Nationally Representative Sample

Key Points CKD is more common among those with steatotic liver disease compared with those without liver disease in the United States. Higher degrees of liver fibrosis are associated with greater prevalence of CKD independent of other common risk factors of kidney disease. Background Steatotic liver disease (SLD) and CKD are common conditions that are strongly associated. Yet, there is a paucity of data regarding the prevalence of this overlap and the factors that may drive its occurrence. Methods Using the National Health and Nutrition Examination Survey, we examined trends among adult participants from 2005 to 2020 that defined SLD using the Fatty Liver Index. We completed correlative analyses among adult participants from 2017 to 2020 that defined SLD on the basis of FibroScan results. We used multivariable survey-weighted binomial generalized linear models to determine the factors that were associated with CKD, defined as eGFR <60 or urine albumin-creatinine ratio >30. Results Among the 76,496 participants included in trend analyses, the estimated prevalence of CKD was 15.7% (95% confidence interval [CI], 15.2% to 16.2%) and SLD was 42.3% (95% CI, 41.4% to 43.2%). As compared with those without SLD, those with SLD had a significantly higher estimated prevalence of CKD (SLD, 15.7%; 95% CI, 14.9% to 16.5%; versus no SLD, 11.2%; 95% CI, 10.7% to 11.7%). In multivariate analyses of 3667 participants who underwent FibroScan and had SLD defined using the Fatty Liver Index, adjusting for control and presence of diabetes mellitus, hypertension, and hyperlipidemia/dyslipidemia, compared with those with normal liver stiffness, those with moderate scarring (F2) had similar odds of CKD (1.53; 95% CI, 0.91 to 2.56), those with severe scarring (F3) had higher odds of CKD (2.28; 95% CI, 1.20 to 4.32), and those with cirrhosis had higher odds of CKD (2.21; 95% CI, 1.13 to 4.32). Conclusions Our findings highlight that CKD is common among patients with SLD and that higher degrees of hepatic fibrosis are associated with CKD independent of other comorbidities of the metabolic syndrome.