Relationship Between Fibrosis Degree Of Nonalcoholic Fatty Liver Disease And Chronic Kidney Disease

[Objectives]To investigate the predictive value of four noninvasive serological liver fibrosis score indicators in identifying prevalent chronic kidney disease(CKD)among patients with nonalcoholic fatty liver disease(NAFLD)diagnosed by ultrasound;And explored the relationship between the degree of liver fibrosis and CKD in NAFLD patients,To provide a theoretical basis for more comprehensive clinical management of NAFLD and CKD patients.[Methods]A total of 249 patients with NAFLD who were admitted to the Second Affiliated Hospital of Kunming Medical University,from June 2013 to June 2018 were enrolled,and according to whether the patient has chronic kidney disease at the same time,They were divided into group A(NAFLD without CKD)and group B(NAFLD with CKD)Collected patients’ demographics and biochemical indicators.CKD was defined by estimated glomerular filtration rate less than 60ml/min/1.73m2.The severity of hepatic fibrosis was determined by FIB-4 score(Fibrosis index based on the 4 factor),NFS(NAFLD fibrosis score),APRI score(Aspartate aminotransferase to platelet ratio index),BARD score(Body mass index,Aspartate aminotransferase/Alanine aminotrasferase,Diabetes mellitus).They were divided into high fibrosis score group and low fibrosis score group according to the traditional best cutoff values of these four indicators.The risk of CKD is compared between the two groups of patients,and the receiver operating characteristic curve was used to assess the predictive values of each marker.Using CKD as the dependent variable,and four regression variable models were separately constructed with four noninvasive fibrosis scores and the factors which has statistical differences through Univariate analysis,Multivariate logistic regression analysis was performed to analyze the independent risk factors of CKD.[Results]1.Among 249 patients with NAFLD,there were 124 patients in group A(62 were male and 62 were female,with an average age of(50.31 ±13.35)years),and 125 patients in group B(78 males and 47 females,with an average age of(57.79±14.40)years).The age,urea,creatinine,uric acid,and the scores of four non-invasive serous fibrosis markers such as FIB-4,NFS,APRI,BARD were all significantly higher than those of group A,And more men in group B than in group A,the differences were statistically significant(P<0.05).but hemoglobin,platelet count,albumin,ALT,AST,total bilirubin and eGFR were significantly lower than group A(P<0.05),and the differences were also statistically significant(P<0.05).2.Age,urea,creatinine,uric acid,FIB-4 score,NFS score,APRI score,BARD score are negatively correlated with eGFR,among which urea and creatinine are strongly correlated,while hemoglobin,albumin,platelets,ALT,AST,GGT and total bilirubin were positively correlated with eGFR.3.The prevalence of CKD is positively correlated with the prevalence of hypertension(P<0.05).4.Multivariate logistic regression showed that FIB-4,NFS and BARD were independent predictors of CKD.5.The risk of CKD was higher in the high FIB-4 group than in the low FIB-4 group(OR= 2.337,95%CI:1.266～4.313);and the risk of CKD was higher in the high NFS group than in the low NFS group(OR=3.058,95%CI:1.529～6.113);The risk of CKD was higher in the high BARD group than in the low BARD group(OR=3.300,95%CI:1.800～6.048).6.The AUC and optimal cut-off values of the four scores were FIB-4:0.711(1.553),NFS:0.742(-0.510),APRI 0.628(0.386),and BARD:0.636(1.500).The NFS score is the best predictor.[Conclusions]1.In this study,we found that the majority of NAFLD patients with CKD were men,and the level of age,urea,creatinine,uric acid,FIB-4,NFS,APRI,and BARD scores were on the high side,while hemoglobin,platelet,albumin,ALT,AST,total bilirubin and eGFR were on the low side2.The prevalence of CKD in patients with NAFLD is positively correlated with the prevalence of hypertension.3.In this study,we found that four noninvasive serologic scoring systems(FIB-4,NFS,APRI,BARD)were associated with the prevalence of CKD in patients with NAFLD diagnosed by ultrasound,and FIB-4,NFS,BARD were independent risk factors for CKD.4.This study found that a high non-invasive fibrosis score is associated with an increased risk of chronic kidney disease,which suggests that the higher the degree of liver fibrosis,the greater the risk of chronic kidney disease.Therefore,patients with NAFLD should focus on the degree of liver fibrosis,and improve the risk factors for the development of NAFLD and CKD in the early stage,so as to prevent them from happening.5.The AUCs for the diagnosis of chronic kidney disease with four scores in this study were FIB-4(0.711),NFS(0.742),APRI(0.628),and BARD(0.636).NFS shows relatively good accuracy,therefore,FIB-4,NFS,and BARD can be used to quickly and effectively assess the risk of CKD in patients with NAFLD,and to intervene early to improve the quality of life of patients.