Association Between Metabolic Associated Fatty Liver Disease and Chronic Kidney Disease: A Cross-Sectional Study from NHANES 2017–2018

Figures & data

Figure 1 Flowchart of the included 4869 subjects from 9254 subjects in the NHANES 2017–2018 dataset.

Abbreviation: NHANES, National Health and Nutrition Examination Surveys.

Table 1 Baseline Characteristics Before and After Propensity Score (PS) Matching

	Before PSM			After PSM
	Non-MAFLD (n=2104)	MAFLD (n=2765)	p	Non-MAFLD (n=1983)	MAFLD (n=1983)	p
CKD n (%)	418 (19.9)	614 (22.2)	0.048	408 (20.6)	407 (20.5)	0.969
Albuminuria n (%)	242 (11.5)	427 (15.4)	<0.001	233 (11.7)	289 (14.3)	0.016*
eGFR	107.7 (34.3)	76.8 (47.4)	<0.001	100.1 (40.4)	103.0 (40.4)	0.085
Age, years $\overline{x}\pm s$	49.5 (19.1)	53.4 (16.2)	<0.001	50.8 (18.8)	51.1 (16.0)	0.636
Male n (%)	923 (43.9)	1442 (52.2)	<0.001	1068 (46.1)	1028 (51.8)	0.203
Race n (%)			<0.001			0.558
Mexican American n (%)	209 (9.9)	456 (16.5)		209 (10.5)	241 (12.2)
Other Hispanic n (%)	176 (8.4)	289 (10.5)		176 (8.9)	175 (8.8)
Non-Hispanic White n (%)	769 (36.5)	938 (33.9)		718 (36.2)	692 (34.9)
Non-Hispanic Black n (%)	542 (25.8)	559 (20.2)		477 (24.1)	484 (24.4)
Non-Hispanic Asian n (%)	296 (14.1)	384 (13.9)		295 (14.9)	274 (13.8)
Other Race n (%)	112 (5.3)	139 (5.0)		108 (5.4)	117 (5.9)
Overweight n (%)	1059 (52.2)	2630 (95.1)	<0.001	1004 (52.7)	1892 (95.4)	<0.001*
Smoking n (%)	870 (41.3)	1181 (42.7)	0.340	823 (42.0)	834 (42.1)	0.949
Hypertension n (%)	529 (25.1)	998 (36.1)	<0.001	524 (26.5)	679 (34.2)	<0.001*
DM n (%)	198 (9.4)	593 (24.1)	<0.001	196 (9.9)	403 (20.3)	<0.001*
Hyperuricemia n (%)	291 (13.8)	686 (24.8)	<0.001	280 (14.1)	496 (25.0)	<0.001*
Hypertriglyceridemia n (%)	383 (18.2)	1241 (44.9)	<0.001	382 (19.3)	859 (43.3)	<0.001*
Low HDL-C n (%)	223 (10.6)	15 (0.5)	<0.001	197 (9.9)	11 (0.6)	<0.001*
Creatinine, μmol/L $\overline{x}\pm s$	80.3 (38.7)	80.6 (44.9)	0.805	81.1 (39.6)	79.7 (47.3)	0.315
hsCRP, mg/L $\overline{x}\pm s$	3.4 (8.1)	4.8 (8.2)	<0.001	3.4 (8.3)	5.1 (8.3)	<0.001*
ALT IU/L $\overline{x}\pm s$	18.8 (14)	25.0 (17.8)	<0.001	21.6 (13.8)	22.3 (11.9)	0.085
ALP IU/L $\overline{x}\pm s$	77 (29.9)	81.7 (25.2)	0.005	77.6 (30.1)	82.0 (25.3)	<0.001*
GGT IU/L $\overline{x}\pm s$	28.5 (50.1)	35.9 (42.6)	<0.001	159.3 (35.4)	160.4 (34.8)	0.304
FIB-4 Score $\overline{x}\pm s$	1.18 (0.88)	1.01 (1.01)	0.215	1.06 (0.71)	1.2 (0.88)	<0.001*
FIB-4 Category			0.009			<0.001*
FIB-4 < 1.3	1402 (66.8)	1914 (69.5)		1463 (74.0)	1284 (64.9)
1.3≤ FIB-4 < 2.67	596 (28.4)	751 (27.2)		495 (23.2)	595 (30.1)
FIB-4 ≥ 2.67	100 (4.8)	88 (3.2)		55 (2.8)	99 (5.0)
NFS Score $\overline{x}\pm s$	−1.79 (1.54)	−1.01 (1.55)	<0.001	−1.7 (1.53)	−1.2 (1.57)	<0.001*
NFS Category			<0.001			<0.001*
NFS < −1.455	1268 (62.7)	1165 (42.3)		1158 (60.9)	903 (45.7)
−1.455 ≤ NFS < 0.676	617 (30.5)	1239 (45.0)		607 (31.9)	839 (42.2)
NFS ≥ 0.676	136 (6.5)	349 (12.7)		136 (7.2)	235 (11.9)

Notes: *A significant difference between groups. Categorical values are shown as n (%). Continuous variables are shown as mean ± standard deviation.

Abbreviations: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; FIB-4, fibrosis-4; GGT, γ-glutamyl transpeptidase; HDL-C, high-density lipoprotein cholesterol; hsCRP, high-sensitivity C-reactive protein; NFS, NAFLD fibrosis score.

Table 2 Univariate and Logistic Regression Analysis in Patients Based on the PSM

	Non-CKD (n=3151)	CKD (n=815)	p value	Odds Ratio (95% CI)	p value
MAFLD	1576 (50.0)	407 (49.9)	0.969
Age $\overline{x}\pm s$	47.9 (16.5)	63.6 (15.3)	<0.001	1.04 (1.03~1.05)	<0.001*
Male n (%)	1668 (52.9)	428 (52.5)	0.844
Overweight n (%)	2282 (73.5)	614 (78.4)	0.004	0.98 (0.77~1.25)	0.723
Smoking n (%)	1272 (40.4)	394 (48.3)	<0.001	0.92 (0.77~1.10)	0.388
Hypertension n (%)	778 (24.7)	425 (52.1)	<0.001	1.66 (1.38~2.00)	<0.001*
DM n (%)	329 (10.4)	270 (33.1)	<0.001	2.21 (1.89~3.11)	<0.001*
Hyperuricemia n (%)	484 (15.4)	292 (35.8)	<0.001	1.91 (1.55~2.36)	<0.001*
Hypertriglyceridemia n (%)	939 (29.8)	302 (37.1)	<0.001	0.83 (0.69~1.00)	0.055
Low HDL n (%)	159 (5.0)	49 (6.0)	0.270
High hsCRP n (%)	81.1 (39.6)	79.7 (47.3)	0.315
ALT IU/L $\overline{x}\pm s$	22.2 (15.9)	20.8 (17.0)	0.028	1.00 (1.00~1.00)	0.231
ALP IU/L $\overline{x}\pm s$	78.2 (27.0)	85.8 (30.2)	<0.001	1.00 (1.00~1.01)	0.010*
FIB-4 Score	1.0 (0.70)	1.6 (1.0)	<0.001	1.23 (1.05~1.45)	0.011
FIB-4 Category			<0.001
FIB-4 < 1.3	2382 (75.8)	365 (44.8)
1.3≤ FIB-4 < 2.67	684 (21.8)	370 (45.5)
FIB-4 ≥ 2.67	75 (2.4)	79 (9.7)
NFS score	−1.7 (1.4)	−0.40 (1.6)	<0.001	1.09 (0.98~1.20)	0.102
NFS Category			<0.001
NFS < −1.455	1870 (60.7)	194 (24.4)
−1.455 ≤ NFS < 0.676	1041 (33.6)	405 (51.8)
NFS ≥ 0.676	185 (6.0)	186 (23.8)

Notes: *A significant difference between groups. Categorical values are shown as n (%). Continuous variables are shown as mean ± standard deviation.

Abbreviations: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; FIB-4, fibrosis-4; GGT, γ-glutamyl transpeptidase; HDL-C, high-density lipoprotein cholesterol; hsCRP, high-sensitivity C-reactive protein; NFS, NAFLD fibrosis score; PSM, propensity score matching.

Figure 2 Fibrosis classification based on FIB-4 or NFS scores in CKD and non-CKD subjects.

Abbreviations: CKD, chronic kidney disease; FIB-4, fibrosis-4; NFS, NAFLD fibrosis score.

Table 3 Associations Between CKD in Subjects with MAFLD Complicated with DM

	p-value	Odds Ratio (95% CI)
Age	<0.001*	1.04 (1.02~1.07)
Hypertension	0.008*	1.78 (1.16~2.58)
Hyperuricemia	0.002*	2.08 (1.30~3.32)
ALP	0.138	1.01 (1.00, 1.01)
FIB-4 Score	0.985	1.00 (0.77~1.29)
NFS Score	0.357	1.10 (0.90~1.36)

Note: *A significant difference between groups.

Abbreviations: MAFLD, metabolic associated fatty liver disease; ALP, alkaline phosphatase; FIB-4, fibrosis-4; NFS, NAFLD fibrosis score.

Table 4 Associations Between CKD in DM Subjects Not Complicated with MAFLD

	p-value	Odds Ratio (95% CI)
Age	0.002*	1.06 (1.02~1.09)
Hypertension	0.310	1.45 (0.71~2.95)
Hyperuricemia	0.003*	3.52 (1.52~8.15)
ALP	0.014*	1.02 (1.00~1.03)
FIB-4 Score	0.264	0.79 (0.52~1.19)
NFS Score	0.022	1.51 (1.01~2.15)

Note: *A significant difference between groups.

Abbreviations: MAFLD, metabolic associated fatty liver disease; ALP, alkaline phosphatase; FIB-4, fibrosis-4; NFS, NAFLD fibrosis score.

Table 5 Associations Between CKD in Subjects with MAFLD Not Complicated with DM

	p-value	Odds Ratio (95% CI)
Age	0.002*	1.02 (1.01~1.04)
Hypertension	<0.001	2.01 (1.54~2.86)
Hyperuricemia	<0.001*	2.25 (1.30~3.07)
ALP	0.021*	1.01 (1.00, 1.01)
FIB-4 Score	0.060	1.00 (0.77~1.29)
NFS Score	0.494	1.05 (0.91~1.21)

Note: *A significant difference between groups.

Abbreviations: MAFLD, metabolic associated fatty liver disease; ALP, alkaline phosphatase; FIB-4, fibrosis-4; NFS, NAFLD fibrosis score.