Table 2. Consensus statements on MAFLD and risk of CKD.
| Domain and statements | Grade |
|---|---|
| 1. Epidemiology of MAFLD and CKD | |
| 1.1 The prevalence of CKD in individuals with MAFLD is higher compared to that in the non-MAFLD population | U |
| 1.2 MAFLD is an independent risk factor for CKD in patients with T2D, even after adjustment for common risk factors for CKD | A |
| 1.3 MAFLD is an independent risk factor for CKD in patients without T2D, even after adjustment for common risk factors for CKD | A |
| 1.4 MAFLD is associated with a greater risk of CKD than patients with liver fat but without evidence of systemic metabolic dysregulation | A |
| 1.5 MAFLD is associated with an increased incidence of CKD | U |
| 1.6 CKD increases the risk of overall mortality among patients with MAFLD | A |
| 2. Severity of MAFLD and CKD | |
| 2.1 The prevalence of CKD more strongly associates with steatohepatitis compared to simple steatosis | A |
| 2.2 The incidence of CKD more strongly associates with steatohepatitis compared to simple steatosis | A |
| 2.3 MAFLD with advanced fibrosis (stage F3/4) has a higher prevalence of CKD than MAFLD without advanced fibrosis (stage F0–2) | U |
| 2.4 MAFLD with advanced fibrosis (stage F3/4) has a higher incidence of CKD than MAFLD without advanced fibrosis (stage F0–2) | U |
| 2.5 Advanced liver fibrosis in patients with MAFLD is independently associated with an increased risk of incident CKD in patients with T2D | U |
| 2.6 Liver stiffness measured by transient elastography is independently associated with an increased presence of albuminuria | A |
| 3. Mechanisms linking MAFLD with CKD | |
| 3.1 MAFLD and CKD share multiple risk factors such as abdominal obesity, insulin resistance, dyslipidemia, hypertension and dysglycemia | U |
| 3.2 The MAFLD-associated genetic polymorphism PNPLA3 rs738409 variant is associated with CKD | B |
| 3.3 Alterations in gut microbiota may be linked to both MAFLD and CKD | A |
| 3.4 Metabolic dysfunction is an important mechanistic link between MAFLD and CKD | U |
| 4. Managing and treating MAFLD and CKD | |
| 4.1 Lifestyle intervention including a hypocaloric diet and regular physical exercise is associated with improvements in both MAFLD and CKD, though the extent of benefit might be different for both diseases | U |
| 4.2 Cardiometabolic risk factors should be treated in patients with MAFLD and CKD | U |
| 4.3 The use of antihypertensive treatment (if required) is important in MAFLD for decreasing risk of CKD | U |
| 4.4 Increased clinical vigilance for presence of severe MAFLD might be considered in patients with CKD | U |
| 4.5 Patients with MAFLD and CKD should ideally be treated in a multidisciplinary team setting, though the ideal care model has not been identified | U |
‘U’ denotes unanimous (100%) agreement, ‘A’ 90–99% agreement, ‘B’ 78–89% agreement, and ‘C’ 67–77% agreement. MAFLD, metabolic dysfunction-associated fatty liver disease; CKD, chronic kidney disease; T2D, type 2 diabetes.