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제목	Metabolic Dysfunction-Associated Fatty Liver Disease and Long-term Kidney Function Decline: A 16-Year Population-Based Cohort Study
저자	Woogyeom Kim
출판정보	2026; 2026(1):
키워드	metabolic dysfunction-associated fatty liver disease, chronic kidney disease, kidney function decline, fatty liver index, population-based cohort study
초록	Objectives: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects up to 40% of adults globally and has been linked to chronic kidney disease (CKD) through shared metabolic pathways. However, the long-term impact of MAFLD on kidney function trajectory over more than a decade remains unclear. Methods: We investigated the association between MAFLD and kidney function decline over 16 years in a large population-based cohort. We conducted a retrospective cohort study using data from the Korean Genome and Epidemiology Study. Among 10,030 participants aged 40–69 years recruited in 2001–2002, we included 8,827 individuals with complete baseline data and at least one follow-up measurement during 16 years of biannual assessments. MAFLD was defined using the fatty liver index (FLI ≥30) combined with metabolic criteria. The primary outcome was the long-term slope of estimated glomerular filtration rate (eGFR) assessed using linear mixed-effects models. The secondary outcome was incident CKD (eGFR <60 ml/min/1.73 m2). Results: At baseline, 45.1% (n=3,978) had FLI-defined MAFLD. Over 16 years, the median annual eGFR decline was −0.61 mL/min/1.73 m2 per year (IQR: −1.97 to 0.83). After adjusting for demographics, comorbidities, and laboratory parameters, MAFLD was independently associated with accelerated eGFR decline (adjusted β coefficient: −0.29; 95% CI:−0.39 to −0.18; P<0.001). During a median follow-up of 15.4-years, 19.5% (n=1,662) developed CKD. MAFLD was associated with a 26% increased risk of incident CKD (adjusted hazard ratio: 1.26, 95% CI: 1.11–1.43; P<0.001). A dose-response relationship was observed between FLI categories and eGFR decline, with higher FLI values predicting steeper kidney function deterioration. Conclusion: In this extended longitudinal analysis, MAFLD was independently associated with accelerated kidney function decline and increased CKD risk over 16 years. These findings highlight the systemic impact of MAFLD on long-term kidney health and support the integration of regular kidney function monitoring into routine care for patients with MAFLD.
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