Relationship between fibrosis degree of nonalcoholic fatty liver disease and chronic kidney disease

Objective To examine the predictive value of four noninvasive fibrosis indices in identifying chronic kidney disease （CKD） among nonalcoholic fatty liver disease （NAFLD）,and investigate the relationship between liver fibrosis scores and CKD in NAFLD patients. Methods A total of 249 NAFLD patients admitted to our hospital from June 2013 to June 2018 were selected and divided into group A （Non-CKD group） and group B （CKD group） according to the presence of CKD.CKD was defined by estimated glomerular filtration rate less than 60 ml/（min · 1.73 m²）.The severity of hepatic fibrosis was determined by FIB-4 score,NFS （NAFLD fibrosis score）,APRI score （AST to platelet ratio index）,BARD score （BMI,AST/ALT,DM）,respectively.Receiver operating characteristic curve was used to assess the predictive value of each marker.Using CKD as the dependent variable,four regression models were separately constructed using four noninvasive fibrosis scores and the factors which had statistical differences tested by univariate analysis. Results Among 249 patients with NAFLD,there were 124 patients in group A and 125 patients in group B.Age,urea,creatinine,uric acid,and the scores of four non-invasive serous fibrosis markers such as FIB-4,NFS,APRI,BARD in group B were all significantly higher than those of group A;However,hemoglobin,platelet count,albumin,ALT,AST,total bilirubin and eGFR were significantly lower than those in group A （all P<0.05）.Multivariate logistic regression showed that FIB-4 （OR,2.337;95% CI,1.052 to 5.193）,NFS （OR,3.058;95% CI,1.100 to 8.500） and BARD （OR,3.300;95% CI,1.524 to 7.148） were independent predictors for CKD.The AUC and optimal cut-off value of the four scores were 0.711 and 1.553 for FIB-4,0.742 and-0.510 for NFS,0.628 and 0.386 for APRI,0.636 and 1.500 for BARD. Conclusion High noninvasive fibrosis score is associated with an increased risk of CKD.FIB-4,NFS,BARD are independent predictors of CKD among individuals with NAFLD,while NFS has optimal predictive ability.