Liver stiffness is associated with progression of albuminuria in patients with type 2 diabetes: NAFLD cohort study

Abstract Aims Previous studies showed the association between liver fibrosis and albuminuria. However, the effect of liver fibrosis on change in albuminuria is unclear. Thus, we investigated the effect of liver fibrosis on change in albuminuria in patients with type 2 diabetes. Methods In this retrospective cohort study, 105 patients with type 2 diabetes concomitant with NAFLD were included. A change in urinary albumin excretion (UAE) was defined as follows: change in UAE = (logarithm (UAE+1) at follow-up examination minus logarithm (UAE+1) at baseline examination)/ follow-up duration (1 year in this study). Elastography was performed to assess controlled attenuation parameter (CAP, dB/m) and liver stiffness measurement (LSM, kPa) values. Results The mean age (standard deviation), body mass index (BMI), CAP and LSM were 63.3 (12.1) years, 25.4 (4.3) kg/m2, 273.1 (53.0) dB/m and 6.2 (3.4) kPa, respectively. Median UAE value (interquartile range) was 16 (6-43) mg/gCr. The LSM was associated with changes in UAE (r = 0.27, p = 0.005). Multiple regression analysis demonstrated that LSM was associated with change in UAE (s = 0.28, p = 0.015) after adjusting for sex, age, duration of diabetes, smoking status, exercise habits, hemoglobin A1c, BMI, eGFR, systolic blood pressure, logarithm (UAE +1) at baseline examination, use of renin-angiotensin system inhibitors, new use of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1, and CAP. Conclusions Liver stiffness is an independent risk factor for the progression of albuminuria in patients with type 2 diabetes.