Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

Chao Sun, George Boon Bee Goh, Wan Cheng Chow, Wah Kheong Chan, Grace Lai Hung Wong, Wai Kay Seto, Yi Hsiang Huang, Han Chieh Lin, I. Cheng Lee, Hye Won Lee, Seung Up Kim, Vincent Wai Sun Wong*, Jian Gao Fan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Nonalcoholic fatty liver disease (NAFLD) is associated with impaired renal function, and both diseases often occur alongside other metabolic disorders. However, the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear. The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients. Methods: All adults aged 18–70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study. Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase (FAST), Agile 3+ and Agile 4 scores. Impaired renal function and chronic kidney disease (CKD) were defined by an estimated glomerular filtration rate (eGFR) with value of < 90 mL/min/1.73 m2 and < 60 mL/min/1.73 m2, respectively, as estimated by the CKD-Epidemiology Collaboration (CKD-EPI) equation. Results: Among 529 included NAFLD patients, the prevalence rates of impaired renal function and CKD were 37.4% and 4.9%, respectively. In multivariate analysis, a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+ and Agile 4 scores were independent risk factors for CKD (P < 0.05). Furthermore, increased fasting plasma glucose (FPG) and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome (P < 0.05). Compared with patients with normoglycemia, those with prediabetes [FPG ≥ 5.6 mmol/L or hemoglobin A1c (HbA1c) ≥ 5.7%] were more likely to have impaired renal function (P < 0.05). Conclusions: Agile 3+ and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD. Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

Original languageEnglish
Pages (from-to)241-248
Number of pages8
JournalHepatobiliary and Pancreatic Diseases International
Issue number3
StatePublished - Jun 2024


  • Agile 3+
  • Agile 4
  • Impaired renal function
  • Metabolic syndrome
  • Nonalcoholic fatty liver disease


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