Non-alcoholic fatty liver and chronic kidney disease: Retrospect, introspect, and prospect

Table 4 Summary of Interventions for patients with nonalcoholic fatty liver disease and chronic kidney disease

Intervention	Ref.	Year	n	Findings	Recommendation
Decreasing WHR	Chon et al[43]. 12-yr prospective cohort	2020	6137	A decrease in the WHR of more than 5% in patients with NAFLD leads to a significantly reduced risk of CKD development, even in non-obese patients	Serial Monitoring WHR may be beneficial in identifying patients with NAFLD at risk of developing CKD and reduction can ameliorate the progression
Weight loss	Vilar-Gomez et al[94]. Post-hoc analysis	2017	261	Improvement in liver histology due to weight loss linked to improved renal outcomes, even after adjusting for medication profile, diabetes, and hypertension	Advocate for weight loss
SGLT2 Inhibitors	Shimizu et al[96]. RCT	2019	57	SGLT inhibitor (Dapagliflozin) improved liver steatosis in patients with T2DM and NAFLD and attenuates liver fibrosis in patients with NAFLD-related advanced fibrosis	Although data is not sufficient, consider using SGLT2 inhibitors in T2DM patients with NAFLD and CKD
	Perkovic et al[95]. CREDENCE trial	2019	4401	SGLT2 inhibitor (Canagliflozin) decreased the risk of renal failure in patients with T2DM and CKD
GLP-1	Armstrong et al[100]. LEAN trial	2016	52	Liraglutide led to weight loss, glycemic control, and histological resolution of NASH	GLP-1’s in NASH is considered effective in improving components of MetS, however, long-term studies are needed to determine NASH-related outcomes
	Tuttle et al[101]. AWARD-7 trial	2018	577	Once-weekly dulaglutide is associated with reduced decline in eGFR, while being as effective as insulin in achieving glycemic control	GLP-1 is a safe option for patients with CKD and is associated with slower progression of CKD
Coenzyme Q10	Farhangi et al[109] and Farsi et al[110]. RCT	2014[109] and 2016[110]	44[109] and 41[110]	100 mg of oral CoQ10/d improve biochemical variables of NAFLD after 4 wk[109] and 12 wk[110] of treatment	Due to lack of data in patients with both NAFLD and CKD, the benefit of CoQ10 supplementation is unknown; however, in separate trials with regards to both NAFLD and CKD, CoQ10 supplementation is beneficial
	Yeung et al[111]. RCT	2015	15	Oral CoQ10 supplementation in patients with CKD showed significant improvement in serum creatinine when compared to placebo

WHR: Waist-to-hip ratio; NAFLD: Nonalcoholic fatty liver disease; CKD: Chronic kidney disease; SGLT2: Sodium-glucose co-transporter-2; RCT: Randomized controlled trial; T2DM: Type 2 Diabetes Mellitus; GLP-1: Glucagon-like peptide receptor agonist; NASH: Non-alcoholic steatohepatitis.