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Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease

Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease
Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease
Objectives: To investigate if non-alcoholic fatty liver disease (NAFLD) impacts mortality and adverse outcomes for individuals with chronic kidney disease (CKD). Design: Systematic review. Data sources: PubMed, EMBASE and Web of Science were searched up to 1 February 2020 with no restriction on the earliest date. Eligibility criteria for selecting studies: Observational cohort studies that reported either the risk of all-cause mortality, incidence of non-fatal cardiovascular events (CVE) or progression of kidney disease among adults with established CKD who have NAFLD compared with those without. Data extraction and synthesis: Two reviewers extracted data and assessed bias independently. Results: Of 2604 records identified, 3 studies were included (UK (n=852), South Korea (n=1525) and USA (n=1413)). All were judged to have a low or moderate risk of bias. Data were insufficient for meta-analysis. Two studies examined the influence of NAFLD on all-cause mortality. One reported a significant positive association for NAFLD with all-cause mortality for individuals with CKD (p<0.05) (cardiovascular-related mortality p=ns), which was lost following adjustment for metabolic risk factors; the second reported no effect in adjusted and unadjusted models. The latter was the only study to report outcomes for non-fatal CVEs and observed NAFLD to be an independent risk factor for this (propensity-matched HR=2.00, p=0.02). Two studies examined CKD progression; in one adjusted rate of percentage decline in estimated glomerular filtration rate per year was found to be increased in those with NAFLD (p=0.002), whereas the other found no significant difference. Conclusions: Few studies have examined the influence of NAFLD on prognosis and major adverse clinical outcomes within the CKD population. The studies identified were diverse in design and results were conflicting. This should be a focus for future research as both conditions continue to rise in prevalence and have end-stage events associated with significant health and economic costs. PROSPERO registration number CRD42020166508.
chronic renal failure, end stage renal failure, hepatology, myocardial infarction
2044-6055
Hydes, Theresa June
c7744323-57ce-48fd-be8d-e299554297d9
Buchanan, Ryan
9499f713-f684-4046-be29-83cd9d6f834d
Kennedy, Oliver
96f5e8fc-f18e-4887-8504-77ffef83c7f1
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Hydes, Theresa June
c7744323-57ce-48fd-be8d-e299554297d9
Buchanan, Ryan
9499f713-f684-4046-be29-83cd9d6f834d
Kennedy, Oliver
96f5e8fc-f18e-4887-8504-77ffef83c7f1
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Hydes, Theresa June, Buchanan, Ryan, Kennedy, Oliver, Fraser, Simon, Parkes, Julie and Roderick, Paul (2020) Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease. BMJ Open, 10 (9), [e040970]. (doi:10.1136/bmjopen-2020-040970).

Record type: Article

Abstract

Objectives: To investigate if non-alcoholic fatty liver disease (NAFLD) impacts mortality and adverse outcomes for individuals with chronic kidney disease (CKD). Design: Systematic review. Data sources: PubMed, EMBASE and Web of Science were searched up to 1 February 2020 with no restriction on the earliest date. Eligibility criteria for selecting studies: Observational cohort studies that reported either the risk of all-cause mortality, incidence of non-fatal cardiovascular events (CVE) or progression of kidney disease among adults with established CKD who have NAFLD compared with those without. Data extraction and synthesis: Two reviewers extracted data and assessed bias independently. Results: Of 2604 records identified, 3 studies were included (UK (n=852), South Korea (n=1525) and USA (n=1413)). All were judged to have a low or moderate risk of bias. Data were insufficient for meta-analysis. Two studies examined the influence of NAFLD on all-cause mortality. One reported a significant positive association for NAFLD with all-cause mortality for individuals with CKD (p<0.05) (cardiovascular-related mortality p=ns), which was lost following adjustment for metabolic risk factors; the second reported no effect in adjusted and unadjusted models. The latter was the only study to report outcomes for non-fatal CVEs and observed NAFLD to be an independent risk factor for this (propensity-matched HR=2.00, p=0.02). Two studies examined CKD progression; in one adjusted rate of percentage decline in estimated glomerular filtration rate per year was found to be increased in those with NAFLD (p=0.002), whereas the other found no significant difference. Conclusions: Few studies have examined the influence of NAFLD on prognosis and major adverse clinical outcomes within the CKD population. The studies identified were diverse in design and results were conflicting. This should be a focus for future research as both conditions continue to rise in prevalence and have end-stage events associated with significant health and economic costs. PROSPERO registration number CRD42020166508.

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More information

Accepted/In Press date: 11 August 2020
e-pub ahead of print date: 28 September 2020
Keywords: chronic renal failure, end stage renal failure, hepatology, myocardial infarction

Identifiers

Local EPrints ID: 444168
URI: http://eprints.soton.ac.uk/id/eprint/444168
ISSN: 2044-6055
PURE UUID: 8eaad009-1fa9-41cf-8bae-c32b8f26f57b
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 30 Sep 2020 16:30
Last modified: 26 Nov 2021 02:53

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Contributors

Author: Theresa June Hydes
Author: Ryan Buchanan
Author: Oliver Kennedy
Author: Simon Fraser ORCID iD
Author: Julie Parkes ORCID iD
Author: Paul Roderick ORCID iD

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