Background: Nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are highly prevalent in type 2 diabetes mellitus (T2DM). Growing evidence suggests that NAFLD and CKD share common traditional risk factors, but it would seem unique risk pathways are involved as a consequence of NAFLD and CKD, efforts are still needed for a more comprehensive understanding of these relationship.

Methods: A structural equation model (SEM) was applied to assess associations between demographic data, inflammation factor, anthropometric and metabolic variables simultaneously and estimated glomerular filtration rate (eGFR) and fatty liver index (FLI). Given the potential that the NAFLD and CKD relationship may be bidirectional, SEMs also to examine direct and indirect effects of NAFLD on CKD, and vice versa.

Results: A total of 1,992 subjects with T2DM were enrolled in this study. Using multivariate analysis, NAFLD was independently associated with the risk of CKD (adjusted OR=1.59, 95% CI=1.12-2.25, P=0.009). SEMs showed that age (-0.216), triglyceride (-0.129), uric acid (UA, -0.415), albumin (0.163), and HbA1c (-0.066) levels had direct effects on eGFR, and the final model could explain 30% of the variability in eGFR. Age (0.094), triglyceride (0.174), body mass index (BMI) (0.707), UA (0.092), white blood cell (WBC) count (0.070), serum glutamic pyruvic transaminase (0.132) levels, and smoking (0.066) status had direct effects on FLI, and the final model could explain 67% of the variability in FLI. The common risk factors contributed to both eGFR and FLI were age, triglyceride, and UA. Unique risk factors were albumin and HbA1c for eGFR, and BMI, WBC, SGPT, and smoking for FLI. SEMs analysis confirm the bidirectional cause-relationships between NAFLD and CKD.

Conclusions: Common and unique risk factors and bidirectional relationship exist between CKD and NAFLD in patients with T2DM.


H. Hsu: None. Y. Chang: None. L. An: None. T. Lee: None.

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