Chronic Kidney Disease Risk Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Nationwide Cohort Study in Korea

Abstract

Aim: The shift in terminology from nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD) highlights its association with metabolic dysfunction. MASLD is defined by hepatic steatosis and at least one cardiometabolic risk factor (CMRF), which contribute to chronic kidney disease (CKD). This study examines the relationship between MASLD and CKD, the independent impact of CMRFs on CKD risk, and the cumulative effect of multiple CMRFs on CKD development. Methods: The present retrospective cohort study utilized data from the Korean National Health Insurance System (NHIS), analyzing 211,992 individuals aged ≥ 40 years who underwent health screenings between 2009 and 2010. The average observation period was 9.1 years. Participants were classified into groups: no steatotic liver disease (SLD) without CMRF, no SLD with CMRF, MASLD, and metabolic dysfunction-associated steatotic liver disease with increased alcohol intake (MetALD). Results: Compared to the no SLD without CMRF group, the adjusted hazard ratios (HRs) for CKD were 1.27 (95% CI: 1.18–1.37) for no SLD with CMRF, 1.70 (95% CI: 1.58–1.83) for MASLD, and 1.47 (95% CI: 1.33–1.63) for MetALD. CKD risk increased with the number of CMRFs, with adjusted HRs increasing from 1.12 (one CMRF) to 1.97 (four CMRFs). Conclusions: MASLD is independently associated with increased CKD risk. Each CMRF independently contributes to CKD development, and the cumulative effect of multiple CMRFs further amplifies this. This suggests that MASLD is an effective predictor of CKD risk. Given the rising burden of MASLD and its complications, early identification and management of risk factors are crucial for reducing CKD incidence.