Metabolic dysfunction‐associated steatotic liver disease (SLD) and alcohol‐associated liver disease, but not SLD without metabolic dysfunction, are independently associated with new onset of chronic kidney disease during a 10‐year follow‐up period

Abstract Aims The new nomenclature of steatotic liver disease (SLD) including metabolic dysfunction‐associated SLD (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol‐associated liver disease (ALD) has recently been proposed. We aimed to elucidate the relationship between each category of SLD and chronic kidney disease (CKD). Methods We investigated the effects of various SLDs on the development of CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 or positive for urinary protein, during a 10‐year period in 12 138 Japanese subjects (men / women, 7984/4154; mean age, 48 years) who received annual health examinations including abdominal ultrasonography. Results The prevalences of SLD without metabolic dysfunction (SLD‐MD[−]), MASLD, MetALD, and ALD were 1.7%, 26.3%, 4.9%, and 1.9%, respectively. During the follow‐up period, 1963 subjects (16.2%) (men / women, 1374 [17.2%]/589 [14.2%]) had new onset of CKD. Multivariable Cox proportional hazard model analyses after adjustment of age, sex, eGFR, current smoking habit, diabetes mellitus, hypertension, and dyslipidemia showed that the hazard ratios (HR [95% confidence interval]) for the development of CKD in subjects with MASLD (1.20 [1.08–1.33], p = 0.001) and those with ALD (1.41 [1.05–1.88], p = 0.022), but not those with MetALD (1.11 [0.90–1.36], p = 0.332), were significantly higher than the HR in subjects with non‐SLD. Interestingly, subjects with SLD‐MD[−] had a significantly lower HR (0.61 [0.39–0.96], p = 0.034) than that in subjects with non‐SLD. The addition of the novel classification of SLDs into traditional risk factors for the development of CKD significantly improved the discriminatory capacity. Conclusions MASLD and ALD, but not SLD‐MD[−], are independently associated with the development of CKD.