Associazione tra epatopatia steatosica non alcolica (NAFLD) e malattia renale cronica in pazienti affetti da diabete mellito tipo 1.

Background/Objective. Recent epidemiological studies have shown a strong, independent association between non-alcoholic fatty liver disease (NAFLD) and the risk of incident chronic kidney disease (CKD) both in patients without diabetes and in those with type 2 diabetes. Presently, there is no information about the role of NAFLD in predicting the development of CKD in people with type 1 diabetes. Materials and Methods. We studied 261 type 1 diabetic adults without a history of prior hepatic diseases or excessive alcohol consumption and with preserved kidney function (i.e. estimated glomerular filtration rate [eGFRMDRD] ≥60 ml/min/1.73 m2) and with no macroalbuminuria at baseline. These patients were followed for a mean period of 5.2 years for the occurrence of incident CKD (defined as eGFR <60 ml/min/1.73 m2 and/or macroalbuminuria). NAFLD was diagnosed by ultrasonography in all partecipants. Results. At baseline, patients had a mean eGFRMDRD of 92±23 ml/min/1.73 m2; 234 (89.7%) of them had normoalbuminuria and 27 (10.3%) microalbuminuria. NAFLD was present in 131 (50.2%) patients. During the follow-up, 61 subjects developed incident CKD. NAFLD was associated with an increased risk of incident CKD (hazard ratio [HR] 2.85; 95% CI 1.59-5.10, p<0.001). Adjustments for age, sex, duration of diabetes, hypertension (i.e. blood pressure ≥140/90 mmHg or drug treatment), HbA1c and baseline eGFRMDRD did not appreciably attenuate this association (adjusted-HR 2.03, 95% CI 1.10-3.77, p<0.01). Results remained unchanged after excluding those (n=27) who had microalbuminuria at baseline (adjusted-HR 1.85; 95% CI 1.03-3.27, p<0.05). Conclusions. This is the first study to demonstrate that NAFLD as detected by ultrasonography is strongly associated with an increased incidence of CKD, independently of traditional cardio-renal risk factors, in adults with type 1 diabetes. Further studies are needed to confirm these findings and to elucidate the putative biological mechanisms underlying this association.