Kidney Week

Abstract: FR-PO1118

Metabolic Dysfunction-Associated Fatty Liver Disease Increases the Risk of CKD in a Young to Middle-Aged Population

Session Information

• Health Maintenance, Nutrition, and Metabolism
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Kuma, Akihiro, Hyogo Medical University, Nishinomiya, Japan

Akihiro Kuma, MD, PhD

• Mimura, Yasuyuki, Hyogo Medical University, Nishinomiya, Japan

Yasuyuki Mimura, MD

• Iwasaki, Takahide, Hyogo Medical University, Nishinomiya, Japan

Takahide Iwasaki, MD, PhD

• Nanami, Masayoshi, Hyogo Medical University, Nishinomiya, Japan

Masayoshi Nanami

• Kuragano, Takahiro, Hyogo Medical University, Nishinomiya, Japan

Takahiro Kuragano, PhD

Background

Patients with liver disease have a higher prevalence of chronic kidney disease (CKD) than those without. Metabolic dysfunction–associated fatty liver disease (MAFLD) has recently been identified as a lifestyle-related disease; however, its association between with CKD development remains unclear. This study investigated whether MAFLD is associated with CKD development in a young to middle-aged population.

Methods

This retrospective observational study utilized annual health checkup data from Japanese individuals aged 20–60 years, collected between 2009–2014. Participants with an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m² at baseline were excluded. CKD development was defined as having an eGFR of <60 mL/min/1.73 m² five years later. The FIB-4 score was calculated using age, AST and ALT levels, and platelet count. A FIB-4 score of ≥1.30 was considered high. MAFLD was diagnosed using the fatty liver index (FLI)—calculated from body mass index, waist circumference, and triglyceride and γ-GTP levels—in combination with obesity, metabolic disorders, or diabetes mellitus. The primary outcome was the development of CKD after five years, analyzed using logistic regression following propensity score matching.

Results

Of the 11,296 individuals initially recruited, 4,822 (90.6 % male) met the eligibility criteria. Mean age and baseline eGFR were 44.7 years and 77.8 mL/min/1.73 m², respectively. CKD developed in 9.6% of participants. The prevalence rates of MAFLD and high FIB-4 scores were 35.3% and 9.2%, respectively. The FLI was not correlated with the FIB-4 score (r=−0.02, P=0.14). Receiver operating characteristic curve analysis indicated that the FIB-4 score (AUC=0.61, 95% CI: 0.59–0.64) was a better predictor of CKD development than the FLI (AUC=0.55, 95% CI: 0.52–0.58). After propensity score matching, MAFLD was found to be a significant risk factor for CKD development (coefficient=0.039, 95% CI: 0.014–0.064, P=0.002), whereas a high FIB-4 score was not (coefficient=0.016, 95% CI: −0.033 to 0.065, P=0.529).

Conclusion

MAFLD was a significant risk factor for CKD development five years later in a young to middle-aged population; however, the FLI was not a better predictor than the FIB-4 score.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025f1vqs13h