Nonalcoholic Fatty Liver Disease Predicts Acute Kidney Injury Readmission in Heart Failure Hospitalizations: A Nationwide Analysis

Non-Alcoholic Fatty Liver Disease (NAFLD) has been associated with the progression of Chronic Kidney Disease (CKD). However, limited data is available on its impact on Acute Kidney Injury (AKI) in Heart Failure (HF) patients. All primary adult HF admissions from the National Readmission Database (NRD) of 2016-2019 were identified. Admissions from July to December of each year were excluded to allow 6 months of follow-up. Patients were stratified according to the presence of NAFLD. Complex multivariate cox regression was used to adjust for confounders and calculate the adjusted hazard ratio (aHR). A total of 420,893 weighted patients admitted with heart failure were included in our cohort, of whom 780 had a secondary diagnosis of NAFLD. Patients with NAFLD were younger, more likely to be female, and had higher rates of obesity and diabetes mellitus. Both groups had similar rates of CKD irrespective of the stage. NAFLD was associated with an increased risk of 6-month readmission with AKI (26.8% vs. 16.6%, aHR:1.44, 95% CI [1.14-1.82], P=0.003). The mean time to AKI readmission was 150 ± 44 days. NAFLD was associated with a shorter mean time to readmission (145 ± 45 vs. 155 ± 42 days, β = - 10 days, P=0.044). Our study from a national database suggests that NAFLD is an independent predictor of 6-months readmission with AKI in patients admitted with heart failure. Further research is warranted to validate these findings.