Association of Non-alcoholic Fatty Liver Disease with Chronic Kidney Disease: A Systematic Review and Meta-analysis

作者：Giovanni Musso, Roberto Gambino, James H. Tabibian, Mattias Ekstedt, Stergios Kechagias, Masahide Hamaguchi, Rolf Hultcrantz, Hannes Hagström, Seung Kew Yoon, Phunchai Charatcharoenwitthaya, Jacob George, Francisco Barrera, Svanhildur Hafliðadóttir, Einar S. Björnsson, Matthew J. Armstrong, Laurence Hopkins, Xin Gao, Sven Francque, An Verrijken, Yusuf Yılmaz, Keith D. Lindor, Michael Charlton, Robin Haring, Markus M. Lerch, Rainer Rettig, Henry Völzke, Seungho Ryu, Guolin Li, Linda L. Wong, Mariana Verdelho Machado, Helena Cortez‐Pinto, Kohichiroh Yasui, Maurizio Cassader · 发表于：PLoS Medicine · 年份：2014 · DOI：10.1371/journal.pmed.1001680 · 被引用次数：728 · 研究领域：Liver Disease Diagnosis and Treatment、Chronic Kidney Disease and Diabetes、Diabetes, Cardiovascular Risks, and Lipoproteins

BACKGROUND: Chronic kidney disease (CKD) is a frequent, under-recognized condition and a risk factor for renal failure and cardiovascular disease. Increasing evidence connects non-alcoholic fatty liver disease (NAFLD) to CKD. We conducted a meta-analysis to determine whether the presence and severity of NAFLD are associated with the presence and severity of CKD. METHODS AND FINDINGS: English and non-English articles from international online databases from 1980 through January 31, 2014 were searched. Observational studies assessing NAFLD by histology, imaging, or biochemistry and defining CKD as either estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or proteinuria were included. Two reviewers extracted studies independently and in duplicate. Individual participant data (IPD) were solicited from all selected studies. Studies providing IPD were combined with studies providing only aggregate data with the two-stage method. Main outcomes were pooled using random-effects models. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. The influences of age, whole-body/abdominal obesity, homeostasis model of insulin resistance (HOMA-IR), and duration of follow-up on effect estimates were assessed by meta-regression. Thirty-three studies (63,902 participants, 16 population-based and 17 hospital-based, 20 cross-sectional, and 13 longitudinal) were included. For 20 studies (61% of included studies, 11 cross...