Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes
Aims: Longitudinal data linking non-alcoholic fatty liver disease to kidney dysfunction in type 2 diabetes (T2D) are limited. This study evaluated the associations of non-invasive indices of liver steatosis and liver fibrosis with kidney impairment, and the mediatory role of the pro-angiogenic facto...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2024
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| Online Access: | https://hdl.handle.net/10356/172941 |
| _version_ | 1811694712539578368 |
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| author | Moh, Mei Chung Pek, Sharon Li Ting Sze, Kenny Ching Pan Low, Serena Subramaniam, Tavintharan Ang, Keven Tang, Wern Ee Lee, Simon Biing Ming Sum, Chee Fang Lim, Su Chi |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Moh, Mei Chung Pek, Sharon Li Ting Sze, Kenny Ching Pan Low, Serena Subramaniam, Tavintharan Ang, Keven Tang, Wern Ee Lee, Simon Biing Ming Sum, Chee Fang Lim, Su Chi |
| author_sort | Moh, Mei Chung |
| collection | NTU |
| description | Aims: Longitudinal data linking non-alcoholic fatty liver disease to kidney dysfunction in type 2 diabetes (T2D) are limited. This study evaluated the associations of non-invasive indices of liver steatosis and liver fibrosis with kidney impairment, and the mediatory role of the pro-angiogenic factor leucine-rich α-2 glycoprotein 1 (LRG1). Methods: T2D adults (n = 2057) were followed for a mean period of 6.1 ± 1.6 years. Baseline liver steatosis [(hepatic steatosis index (HSI) and Zhejiang University index (ZJU)] and liver fibrosis [aspartate transaminase/alanine transaminase ratio (AAR) and BARD] indices derived from composite scoring systems were calculated. Plasma LRG1 levels were quantified using immunoassay. The study outcomes were progressive kidney function decline defined as estimated glomerular filtration rate (eGFR) decline of ≥ 40% and albuminuria progression defined as an increase in albuminuria category. Results: Cross-sectionally, liver steatosis and liver fibrosis indices were associated with increased albuminuria (urinary albumin/creatinine ratio ≥ 30 µg/mg) and reduced renal function (eGFR < 60 mL/min/1.73 m2) after covariate adjustment, respectively. Approximately 32% of the participants experienced progressive kidney function decline, while 38% had albuminuria worsening over time. Longitudinal analysis revealed that baseline AAR (hazard ratio: 1.56; 95% CI 1.15–2.11) and BARD (hazard ratio: 1.16, 95% CI 1.04–1.28) predicted progressive kidney function decline, partly mediated by LRG1. In contrast, liver steatosis (HSI and ZJU) but not liver fibrosis (AAR and BARD) indices were independently associated with albuminuria progression. Conclusions: Increased liver steatosis scores were associated with albuminuria deterioration. Conversely, liver fibrosis indices may be associated with progressive kidney function decline, potentially driven by increased inflammation and angiogenesis. |
| first_indexed | 2024-10-01T07:11:56Z |
| format | Journal Article |
| id | ntu-10356/172941 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T07:11:56Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | ntu-10356/1729412024-01-03T04:52:09Z Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes Moh, Mei Chung Pek, Sharon Li Ting Sze, Kenny Ching Pan Low, Serena Subramaniam, Tavintharan Ang, Keven Tang, Wern Ee Lee, Simon Biing Ming Sum, Chee Fang Lim, Su Chi Lee Kong Chian School of Medicine (LKCMedicine) Khoo Teck Puat Hospital Saw Swee Hock School of Public Health, NUS Science::Medicine Liver Indices Type 2 Diabetes Aims: Longitudinal data linking non-alcoholic fatty liver disease to kidney dysfunction in type 2 diabetes (T2D) are limited. This study evaluated the associations of non-invasive indices of liver steatosis and liver fibrosis with kidney impairment, and the mediatory role of the pro-angiogenic factor leucine-rich α-2 glycoprotein 1 (LRG1). Methods: T2D adults (n = 2057) were followed for a mean period of 6.1 ± 1.6 years. Baseline liver steatosis [(hepatic steatosis index (HSI) and Zhejiang University index (ZJU)] and liver fibrosis [aspartate transaminase/alanine transaminase ratio (AAR) and BARD] indices derived from composite scoring systems were calculated. Plasma LRG1 levels were quantified using immunoassay. The study outcomes were progressive kidney function decline defined as estimated glomerular filtration rate (eGFR) decline of ≥ 40% and albuminuria progression defined as an increase in albuminuria category. Results: Cross-sectionally, liver steatosis and liver fibrosis indices were associated with increased albuminuria (urinary albumin/creatinine ratio ≥ 30 µg/mg) and reduced renal function (eGFR < 60 mL/min/1.73 m2) after covariate adjustment, respectively. Approximately 32% of the participants experienced progressive kidney function decline, while 38% had albuminuria worsening over time. Longitudinal analysis revealed that baseline AAR (hazard ratio: 1.56; 95% CI 1.15–2.11) and BARD (hazard ratio: 1.16, 95% CI 1.04–1.28) predicted progressive kidney function decline, partly mediated by LRG1. In contrast, liver steatosis (HSI and ZJU) but not liver fibrosis (AAR and BARD) indices were independently associated with albuminuria progression. Conclusions: Increased liver steatosis scores were associated with albuminuria deterioration. Conversely, liver fibrosis indices may be associated with progressive kidney function decline, potentially driven by increased inflammation and angiogenesis. Ministry of Health (MOH) National Medical Research Council (NMRC) This study was supported by the Alexandra Health Fund Ltd through the Science—Translational and Applied Research Grants STAR17202 and STAR19103. The SMART2D cohort was supported by the Singapore Ministry of Health's National Medical Research Council CS-IRG (MOH-000066). Su Chi Lim was supported by the Singapore Ministry of Health's National Medical Research Council NMRC/CSA-INV/0020/2017, MOH-000066, and MOH-0000714-01. 2024-01-03T04:52:09Z 2024-01-03T04:52:09Z 2023 Journal Article Moh, M. C., Pek, S. L. T., Sze, K. C. P., Low, S., Subramaniam, T., Ang, K., Tang, W. E., Lee, S. B. M., Sum, C. F. & Lim, S. C. (2023). Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes. Acta Diabetologica, 60(6), 827-835. https://dx.doi.org/10.1007/s00592-023-02058-3 0940-5429 https://hdl.handle.net/10356/172941 10.1007/s00592-023-02058-3 36943479 2-s2.0-85150497817 6 60 827 835 en STAR17202 STAR19103 MOH-000066 NMRC/CSA-INV/0020/2017 MOH-0000714-01 Acta Diabetologica © 2023 Springer-Verlag Italia S.r.l., part of Springer Nature. All rights reserved. |
| spellingShingle | Science::Medicine Liver Indices Type 2 Diabetes Moh, Mei Chung Pek, Sharon Li Ting Sze, Kenny Ching Pan Low, Serena Subramaniam, Tavintharan Ang, Keven Tang, Wern Ee Lee, Simon Biing Ming Sum, Chee Fang Lim, Su Chi Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| title | Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| title_full | Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| title_fullStr | Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| title_full_unstemmed | Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| title_short | Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| title_sort | associations of non invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes |
| topic | Science::Medicine Liver Indices Type 2 Diabetes |
| url | https://hdl.handle.net/10356/172941 |
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