Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2021; 27(17): 1864-1882
Published online May 7, 2021. doi: 10.3748/wjg.v27.i17.1864
Non-alcoholic fatty liver and chronic kidney disease: Retrospect, introspect, and prospect
Rajiv Heda, Masahiko Yazawa, Michelle Shi, Madhu Bhaskaran, Fuad Zain Aloor, Paul J Thuluvath, Sanjaya K Satapathy
Rajiv Heda, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA 70112, United States
Masahiko Yazawa, Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Michelle Shi, Sanjaya K Satapathy, Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY 11030, United States
Madhu Bhaskaran, Department of Nephrology, Northwell Health/Zucker School of Medicine at Hosftra, Manhasset, NY 11030, United States
Fuad Zain Aloor, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Paul J Thuluvath, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD 21202, United States
Author contributions: Satapathy SK conceptualized the manuscript; Satapathy SK, Heda R, Yazawa M, and Shi M drafted the manuscript; all other authors participated in the critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: The authors has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sanjaya K Satapathy, FAASLD, AGAF, FACG, MBBS, MD, Professor, Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, 400 Community Drive, Manhasset, NY 11030, United States.
Received: January 10, 2021
Peer-review started: January 10, 2021
First decision: February 11, 2021
Revised: March 7, 2021
Accepted: April 7, 2021
Article in press: April 7, 2021
Published online: May 7, 2021

With the growing prevalence of obesity and diabetes in the United States and across the world, a rise in the overall incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) is expected. The risk factors for NAFLD are also associated with the development of chronic kidney disease (CKD). We review the epidemiology, risk factors, genetics, implications of gut dysbiosis, and specific pathogenic mechanisms linking NAFLD to CKD. Mechanisms such as ectopic lipid accumulation, cellular signaling abnormalities, and the interplay between fructose consumption and uric acid accumulation have led to the emergence of potential therapeutic implications for this patient population. Transplant evaluation in the setting of both NAFLD and CKD is also reviewed. Potential strategies for surveillance and management include the monitoring of comorbidities, the use of non-invasive fibrosis scoring systems, and the measurement of laboratory markers. Lastly, we discuss the management of patients with NAFLD and CKD, from preventative measures to experimental interventions.

Keywords: Nonalcoholic fatty liver disease, Chronic kidney disease, Nonalcoholic steatohepatitis, Organ transplant, genetic, Microbiome, Pathophysiology

Core Tip: Patients with non-alcoholic fatty liver disease (NAFLD) are at higher risk for the development of chronic kidney disease (CKD) than the general population. The prevalence of mutual comorbidities in addition to direct pathogenic mechanisms linking NAFLD to the development of CKD can explain this finding. With the breadth of data linking NAFLD to CKD, there are minimal options for treating this patient population. Regardless, we have presented strategies that can be implemented at various levels including surveillance, preventative, and management level.