Kidney Week

Abstract: TH-PO0589

Association Between Fibrosis-4 Index and Kidney Outcomes Among Patients with CKD: The Japan CKD Database

Session Information

• CKD: From Global Burden to Precision Care - Epidemiology, Demographics, Geographies, and Risk Factors
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Sakuma, Hirofumi, Asahikawa Ika Daigaku, Asahikawa, Hokkaido Prefecture, Japan

Hirofumi Sakuma, MD, PhD

• Tatsugawa, Rie, Kawasaki Ika Daigaku, Kurashiki, Okayama Prefecture, Japan

Rie Tatsugawa, MD

• Hirano, Akira, Kawasaki Ika Daigaku, Kurashiki, Okayama Prefecture, Japan

Akira Hirano, MD

• Nagasu, Hajime, Kawasaki Ika Daigaku, Kurashiki, Okayama Prefecture, Japan

Hajime Nagasu, MD, PhD

• Kashihara, Naoki, Kawasaki Ika Daigaku, Kurashiki, Okayama Prefecture, Japan

Naoki Kashihara, MD, PhD

• Nakagawa, Naoki, Asahikawa Ika Daigaku, Asahikawa, Hokkaido Prefecture, Japan

Naoki Nakagawa, MD, PhD, FASN

Group or Team Name

• J-CKD-DB collaborators

Background

The fibrosis-4 index (FIB-4) is recommended as a non-invasive test for assessing the risk of liver fibrosis. Recent studies have suggested that the FIB-4 is associated with the development of chronic kidney disease (CKD), even in populations without liver disease. However, whether the FIB-4 can predict kidney outcomes in patients with CKD remains unknown.

Methods

This retrospective study was conducted using data from the Japan Chronic Kidney Disease Database, a nationwide multicenter registry. Patients aged 20–74 years with an estimated glomerular filtration rate (eGFR) of 15–60 mL/min/1.73 m² were included. Patients were categorized according to baseline FIB-4 into a low–intermediate group (FIB-4<2.67) and a high group (FIB-4≥2.67). A 1:2 propensity score matching was performed to account for differences in age, sex, and eGFR. After matching, annual eGFR slope was evaluated using linear mixed-effects models. The kidney outcome was defined as a ≥40% decline in eGFR, and hazard ratios were estimated using Cox proportional hazards models.

Results

After matching, 2,416 patients were in the low-to-intermediate group, and 1,208 patients were in the high group. The median follow-up period was 4.4 years. The mean (SD) age was 68.9 (5.6) years, median (IQR) eGFR was 49.9 (42.7, 55.2) ml/min/1.73 m², and median FIB-4 was 2.02 (1.48, 2.91). Annual eGFR slopes were –0.90 (95% confidence interval [CI], –1.10 to –0.69) in the high group and –0.69 (95% CI, –0.83 to –0.54) in the low-to-intermediate group. The group difference was –0.21 (95% CI, –0.46 to 0.04; p=0.10). Cox proportional hazards analysis showed that the high group was associated with the incidence of kidney outcome (HR 1.53 [95% CI, 1.29 to 1.82], p<0.01).

Conclusion

In this real-world Japanese cohort, high FIB-4 was significantly associated with a higher risk of kidney outcome. FIB-4 may be useful for risk stratification in patients with CKD.

Figure 1. Cumulative incidence of kidney outcome according to FIB-4