Clinical Outcomes in Patients admitted with Diabetes Mellitus and Chronic Kidney Disease Affected by Non-Alcoholic Fatty Liver Disease

Background/Synopsis It's important to note that the association between non-alcoholic fatty liver disease (NAFLD), diabetes mellitus (DM), and CKD is complex, and additional research is needed to fully understand the underlying mechanisms. NAFLD is considered a risk factor for cardiovascular disease (CVD). Objective/Purpose There's limited scientific evidence examining outcomes among patients with DM and CKD affected by NAFLD. Thus, our objective was to assess clinical outcomes in this specific population. Methods We accessed the National Inpatient Sample from 2017-2020 to identify adult patients with NAFLD hospitalized with DM and CKD. The primary endpoint was inpatient mortality, with secondary endpoints including cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), intubation, length of stay (LOS), and total hospital charges. We utilized multivariable logistic regression analysis to estimate clinical outcomes, considering a significance threshold of P < 0.05. Results 11,300,000 hospitalized patients had DM & CKD where 542,140 (4.8%) had NAFLD. NAFLD and non-NAFLD cohorts had a mean age of 67 vs. 69 yrs; males 53.3% vs 54.1%; Caucasians 58.7% vs 57.8%; HTN 15.6% vs 19.8%; AKI 52% vs 44%; PE 2.5% vs 3.6%; AF 28.2% vs 28.6%; PVD 2.1% vs 3.1%; obesity 24.9% vs 27%; dyslipidemia 47.1% vs 61.2%; history of stroke 1.9% vs 3.1%, COPD 22.8% vs 24.7%; alcohol use 5% vs 1.8%, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). Conclusions NAFLD cohort demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were younger, obese, more female patients, Caucasian, with more frequent AKI and alcohol use, and less frequent HTN, AF, PE, PVD, obesity, dyslipidemia, and history of stroke and COPD. NAFLD is associated with greater risk for cardiovascular events, renal failure, GIB, and ICU care. NAFLD is an important predictor of adverse outcomes in the DM&CKD population. Further research is necessary to describe long-term outcomes.