Increased prevalence of chronic kidney disease in patients with Type 1 diabetes and non-alcoholic fatty liver

Aims We determined whether non-alcoholic fatty liver is associated with an increased prevalence of chronic kidney disease in Type 1 diabetes. Methods We studied 343 patients with Type 1 diabetes, who had no history of excessive alcohol consumption or other secondary causes of chronic liver disease. Non-alcoholic fatty liver was diagnosed by ultrasonography. Chronic kidney disease was defined as presence of either abnormal albuminuria (i.e. urinary albumin/creatinine ratio = 30 mg/g) or estimated glomerular filtration rate of less than 60 ml min-1 1.73 m-2. Results Compared with those without steatosis, patients with non-alcoholic fatty liver (n = 182) had significantly lower estimated GFR (83.0 +/- 27 vs. 93.3 +/- 29 ml min-1 1.73 m-2, P < 0.001) and a greater prevalence of abnormal albuminuria (50.0 vs. 20.5%, P < 0.0001) and chronic kidney disease (54.4 vs. 24.2%, P < 0.0001). Multivariable logistic regression analysis revealed that non-alcoholic fatty liver was associated with an increased risk of either abnormal albuminuria (adjusted odds ratio 2.21, 95% CI 1.24.1, P = 0.01) or chronic kidney disease (adjusted odds ratio 1.93, 95% CI 1.13.6, P = 0.02), independently of age, gender, smoking status, physical activity, diabetes duration, HbA1c, BMI, systolic blood pressure, plasma lipids and use of anti-hypertensive and lipid-lowering medications. Conclusions Our findings demonstrate that ultrasound-diagnosed non-alcoholic fatty liver is associated with a higher prevalence of chronic kidney disease in patients with Type 1 diabetes, independently of several risk factors, including the components of the metabolic syndrome.