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

Abstract

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.