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October 17, 2025PLoS ONE4 citationsOpen Access

Metabolic dysfunction-associated steatotic liver disease (MASLD) can be a possible predictive factor of incident CKD: NAGALA cohort study

YOYuriko OnoKSKimiko SakaiTOTakuro Okamura

Key Result

Metabolic dysfunction-associated steatotic liver disease (MASLD) significantly increased the risk of incident chronic kidney disease over 5 years compared to individuals without steatosis or cardiometabolic risk factors (OR 1.37).

Study Design

Type

Cohort (n=15,873)

Multicenter

No

Structured PICO

Does metabolic dysfunction-associated steatotic liver disease (MASLD) increase the risk of incident chronic kidney disease in a general health checkup population?

P
Population
15,873 individuals undergoing health checkups in Japan, free of baseline CKD, followed for 5 years to assess the incidence of chronic kidney disease.
E
Exposure
Metabolic dysfunction-associated steatotic liver disease (MASLD), defined as hepatic steatosis with alcohol intake below thresholds and at least one cardiometabolic risk factor.
C
Comparator
Individuals without steatotic liver disease and without cardiometabolic risk factors (Group 1).
O
Outcome
Incident chronic kidney disease (CKD), defined as eGFR < 60 mL/min/1.73m² or the presence of proteinuria (+1 to +3) persisting for a minimum of three months, over a 5-year follow-up.surrogate

MASLD is an independent risk factor for the development of incident CKD, highlighting the need for early identification and management of metabolic liver disease to preserve renal function.

Main Result

Odds Ratio: 1.37 (95% CI 1.12–1.67)

Absolute Event Rate: 9.5% vs 4.7%

p-value: p=0.002

Limitations

  • Participants were limited to the Gifu region in Japan, introducing potential selection bias.
  • Participants who developed new internal medical conditions during the study might have dropped out.
  • Dietary data beyond alcohol intake were not collected.
  • Postprandial glucose measurements were unavailable.
  • Selection bias due to participants being from a single region undergoing annual health checkups
  • Potential dropouts of participants who developed new internal medical conditions during the study
  • Lack of dietary data beyond alcohol intake
  • Unavailability of postprandial glucose measurements

Abstract

BACKGROUND: A decade-long follow-up study identified metabolic dysfunction-associated fatty liver disease (MAFLD) as an independent predictor for the onset of chronic kidney disease (CKD). In 2023, a Delphi consensus introduced the term metabolic dysfunction-associated steatotic liver disease (MASLD) as an updated nomenclature. This study aims to evaluate whether MASLD, as the newly defined concept of steatotic liver disease, functions as an independent risk factor for CKD development. Additionally, the study seeks to examine the association between MASLD and CKD, while identifying contributing risk factors. METHODS: This research involved a retrospective cohort study conducted on individuals participating in health checkups at Asahi University Hospital, Japan, from 1994 to 2023. Logistic regression analysis was employed to investigate the relationship between MASLD and the incidence of CKD over a five-year follow-up period. RESULTS: A total of 15,873 participants were included in this study. The incidence of CKD was highest among individuals with MASLD (9.5%). Multivariate analysis demonstrated that MASLD was significantly associated with an increased risk of CKD, with an odds ratio (OR) of 1.37 (95% CI 1.12-1.67, p = 0.002). Additional factors such as age (OR 1.04, 95% CI 1.03-1.05, p < 0.001) and estimated glomerular filtration rate (eGFR) (OR 0.88, 95% CI 0.87-0.89, p < 0.001) were also identified as significant predictors of CKD. These findings suggest a robust association between MASLD and an elevated risk of CKD compared to individuals without steatotic liver disease or cardiometabolic risk factors. CONCLUSIONS: This study establishes MASLD as a significant risk factor for CKD onset. Effective identification and management of MASLD cases are essential to mitigate the incidence of CKD.

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Cite This Study

Ono et al. (2025) conducted a cohort in Metabolic dysfunction-associated steatotic liver disease (MASLD) (n=15,873). Metabolic dysfunction-associated steatotic liver disease (MASLD) vs. No steatotic liver disease and no cardiometabolic risk factors was evaluated on Incidence of chronic kidney disease (CKD) (OR 1.37, 95% CI 1.12-1.67, p=0.002). Metabolic dysfunction-associated steatotic liver disease (MASLD) significantly increased the risk of incident chronic kidney disease over 5 years compared to individuals without steatosis or cardiometabolic risk factors (OR 1.37).

synapsesocial.com/papers/6a7dbf2dc6a1517811339fa7https://doi.org/10.1371/journal.pone.0334720
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