Background & Aims
To clarify the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD).

Methods
The participants were divided into four groups by the presence or absence of fatty liver disease (FLD) and metabolic dysfunction (MD). MAFLD was defined as having both FLD and MD, whereas CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 and/or proteinuria.

Results
In this cross-sectional study of 27,371 participants, the proportions of those in the non-FLD without MD, non-FLD with MD, FLD without MD, and MAFLD groups were 48.7%, 28.2%, 2.3%, and 20.8%, respectively. Compared to non-FLD without MD, MAFLD was at a risk of the presence of CKD (adjusted odds ratio 1.83 [1.66–2.01], p<0.001), whereas FLD without MD was not (1.02 [0.79–1.33], p=0.868). Moreover, compared to FLD without MD, MAFLD was at a risk of the presence of CKD (1.19 [1.09–1.31], p<0.001). In this retrospective cohort study, 16,938 of 27,371 participants underwent a median 4.6 (2.0–8.1) years follow-up, and incident data of non-FLD without MD, non-FLD with MD, FLD without MD, and MAFLD were 21.0, 31.1, 26.1, and 31.1 cases per 1,000 person-years, respectively. Compared to the non-FLD without MD, MAFLD was at a risk of incident CKD (adjusted hazard ratio 1.24 [1.14–1.36], p<0.001), whereas FLD without MD was not (1.11 [0.85–1.41], p=0.433).

Conclusions
MAFLD was at a risk for CKD, whereas FLD without MD was not at a risk for CKD.

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