Onwuzo SS, Hitawala AA, Boustany A, Kumar P, Almomani A, Onwuzo C, Monteiro JM, Asaad I. Prevalence of non-alcoholic fatty liver disease in patients with nephrotic syndrome: A population-based study. World J Hepatol 2023; 15(2): 265-273 [PMID: 36926242 DOI: 10.4254/wjh.v15.i2.265]
Corresponding Author of This Article
Somtochukwu Stephen Onwuzo, MD, Doctor, Internal Medicine, Cleveland Clinic Foundation, 18101 Lorain Road, Cleveland, OH 44111, United States. onwuzos@ccf.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Feb 27, 2023; 15(2): 265-273 Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.265
Prevalence of non-alcoholic fatty liver disease in patients with nephrotic syndrome: A population-based study
Somtochukwu Stephen Onwuzo, Asif Ali Hitawala, Antoine Boustany, Prabhat Kumar, Ashraf Almomani, Chidera Onwuzo, Jessy Mascarenhas Monteiro, Imad Asaad
Somtochukwu Stephen Onwuzo, Asif Ali Hitawala, Antoine Boustany, Prabhat Kumar, Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44111, United States
Ashraf Almomani, Digestive Disease and Hepatology, Cleveland Clinic Foundation Florida, Weston, FI 33331, United States
Chidera Onwuzo, Department of Medicine & Surgery, General Hospital Lagos Island, Lagos Island 101223, Lagos, Nigeria
Jessy Mascarenhas Monteiro, Department of Medicine, Ross University School of Medicine, Bridgetown B11093, St Michael, Barbados
Imad Asaad, Digestive Disease and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44111, United States
Author contributions: Onwuzo S designed the research study; Hitawala A and Boustany A performed the biostatistical analysis; Boustany A and Kumar P carried out the data collection; Onwuzo S, Hitawala A, Onwuzo C, Almomani A, Monteiro J, and Asaad I contributed to the manuscript writing, editing and scientific review; All authors have read and agree to the submitted version of the manuscript.
Institutional review board statement: Our cohort’s data were obtained using a validated, multicentered and daily-updated database called Explorys (Explorys Inc, Cleveland, OH, United States). Explorys does not record individual patient data such as name, laboratory or imaging results. Patient’s informed consent and approval of Institutional Review Board are not required since Explorys is a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform.
Informed consent statement: Consent was not obtained but the presented data are anonymized without any risk of identification.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at onwuzos@ccf.org. Consent was not obtained but the presented data are anonymized without any risk of identification.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Somtochukwu Stephen Onwuzo, MD, Doctor, Internal Medicine, Cleveland Clinic Foundation, 18101 Lorain Road, Cleveland, OH 44111, United States. onwuzos@ccf.org
Received: December 6, 2022 Peer-review started: December 6, 2022 First decision: January 11, 2023 Revised: January 21, 2023 Accepted: February 8, 2023 Article in press: February 8, 2023 Published online: February 27, 2023 Processing time: 79 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background
Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide, with hyperlipidemia as one of its risk factors. Nephrotic syndrome (NS) is known to cause hyperlipidemia. Since both NAFLD and NS patients are known to have abnormalities in lipid metabolism, patients with NS might be at increased risk of developing NAFLD.
Research motivation
Given the increasing prevalence of NAFLD and associated morbidity and mortality, assessment of risk factors for targeted surveillance is warranted. This might help in early diagnosis of NAFLD and improve outcomes. We hypothesized that the excess synthesized and circulating lipids in patients with NS affect fat metabolism in the liver, increasing the risk of NAFLD.
Research objectives
To conduct a cross-sectional population-based study to assess the prevalence of NAFLD in patients with NS while adjusting for common risk factors.
Research methods
A large multicenter database (Explorys Inc., Cleveland, OH, United States) was utilized for this study. A cohort of patients with a diagnosis of “Non-Alcoholic fatty liver disease” was identified. Inclusion criteria were age ≥ 18 years, presence of NAFLD, presence of NS. There were no specific exclusion criteria. Univariate and multivariate analyses were performed to adjust for multiple risk factors including age, gender, Caucasian race, nephrotic syndrome, type II diabetes mellitus, hypothyroidism, dyslipidemia, obesity, metabolic syndrome and chronic kidney disease. Statistical analysis was conducted using R, and for all analyses, a 2-sided P value of < 0.05 was considered statistically significant.
Research results
In multivariate analysis, the odds of having NAFLD amongst patients with NS was 1.85 (95%Cl 1.70-2.02), while the odds also remained high in patients that have type 2 diabetes mellitus (OR 3.84), hypothyroidism (OR 1.57), obesity (OR 5.10), hyperlipidemia (OR 3.09), metabolic syndrome (OR 3.42) and chronic kidney disease (CKD) (OR 1.33).
Research conclusions
Our study demonstrates that patients with NS are frequently found to have NAFLD, even when adjusting for common risk factors including CKD. Further studies are required to confirm these findings, investigate causality and assess the utility of surveillance strategies for NAFLD in patients with NS.
Research perspectives
Studies assessing associations of NAFLD with other diseases can help identify at-risk populations that may benefit from routine screening. While patients with NS seem to have higher prevalence of NAFLD, further research is required to assess if routine surveillance of patients with NS is cost-effective and improves outcomes.
