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Kidney Week

Abstract: PO0550

Incidence and Predictors of Non-Alcoholic Fatty Liver Disease in CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Gregg, L Parker, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing due to the global epidemics of obesity and diabetes mellitus, which are commonly seen in CKD. We studied the incidence and predictors of NAFLD in those with CKD.


We conducted a retrospective cohort study of patients with incident CKD (eGFR <60 mL/min/1.73 m2 for ≥90 days) in the Veterans Health Administration from 2005-2016. Patients with no NAFLD at the time of CKD diagnosis were followed for a primary outcome of NAFLD, defined as development of sustained elevated alanine aminotransferase levels in the absence of hepatitis B or C virus infection or alcoholic liver disease, identified by laboratory values and diagnosis codes. We calculated incidence rates for NAFLD for the entire study population and by CKD stage. Predictors of NAFLD were evaluated using Cox proportional hazards regression, considering death and ESKD as competing risks.


Of 1,155,901 veterans with CKD but no NAFLD, 51,584 (4.4%) developed NAFLD at a rate of 0.86 (0.85-0.87) per 100 person-years during 4.74 years follow-up. A total of 3.9% developed ESKD at a rate of 0.76 (0.75-0.77) per 100 person-years, and 33% died at a rate of 6.5 (6.5-6.5) per 100 person-years during the same time period. In a multivariable model, age >50 (vs. 40-49 years) (HR 0.72, 95% CI 0.67, 0.77), women, blacks and veterans with advanced CKD were less likely to develop NAFLD; however, presence of diabetes, higher BMI, anemia, CHF, and hypertension were associated with higher risk of developing NAFLD (Table).


Patients with CKD have a high incidence of NAFLD, which was associated with diabetes, BMI, and CHF. Future studies should determine if interventions targeting these factors may reduce NAFLD risk.

Factors associated with incident NAFLD in CKD
VariableLevelHR (95% CI)
SexFemale0.88 (0.83, 0.92)
RaceBlacks (vs. Whites)0.66 (0.64, 0.68)
CKD Stage (Ref: Stage 3A)Stage 3B0.89 (0.87, 0.91)
 Stage 40.77 (0.74, 0.81)
 Stage 50.60 (0.50, 0.74)
Comorbid conditionDiabetes 1.18 (1.15, 1.20)
 BMI >251.24 (1.20, 1.28)
 BMI >301.43 (1.39, 1.48)
 CHF1.03 (1.00, 1.07)
 Coronary heart disease1.18 (1.13, 1.24)
 Hypertension1.04 (1.02, 1.07)