Non-alcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in more than 5% of hepatocytes in the absence of excessive alcohol consumption and other secondary causes of hepatic steatosis. In 2020, the more inclusive term metabolic (dysfunction)-associated fatty liver disease (MAFLD) — defined by broader diagnostic criteria — was proposed to replace the term NAFLD. The new terminology and revised definition better emphasize the pathogenic role of metabolic dysfunction and uses a set of definitive, inclusive criteria for diagnosis. Diagnosis of MAFLD is based on evidence of hepatic steatosis (as assessed by liver biopsy, imaging techniques or blood biomarkers and scores) in persons who are overweight or obese and have type 2 diabetes mellitus or metabolic dysregulation, regardless of the coexistence of other liver diseases or excessive alcohol consumption. The known association between NAFLD and chronic kidney disease (CKD) and our understanding that CKD can occur as a consequence of metabolic dysfunction suggests that individuals with MAFLD — who by definition have fatty liver and metabolic comorbidities — are at increased risk of CKD. In this Perspective article, we discuss the clinical associations between MAFLD and CKD, the pathophysiological mechanisms by which MAFLD may increase the risk of CKD and the potential drug treatments that may benefit both conditions.
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The authors’ work was supported by grants from the National Natural Science Foundation of China (82070588, 82000690), High Level Creative Talents from the Department of Public Health in Zhejiang Province, Project of New Century 551 Talent Nurturing in Wenzhou and a Project of Science and Technology Development Fund in Wuxi (N20202001). D.-Q.S. is supported in part by grants from the Youth Research Project Fund from Wuxi Municipal Health Commission (Q201932), Top-notch Talents from Young and Middle-Age Health Care in Wuxi (BJ2020026). G.T. is supported in part by grants from the University School of Medicine of Verona, Verona, Italy. C.D.B. is supported in part by the Southampton NIHR Biomedical Research Centre (IS-BRC-20004), UK.
The authors declare no competing interests.
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Wang, TY., Wang, RF., Bu, ZY. et al. Association of metabolic dysfunction-associated fatty liver disease with kidney disease. Nat Rev Nephrol 18, 259–268 (2022). https://doi.org/10.1038/s41581-021-00519-y
Nature Reviews Nephrology (2022)