MAFLD and glomerular hyperfiltration in subjects with prediabetes, visceral obesity and "preserved" kidney function: A cross-sectional study

Aims: To investigate the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) in prediabetes, visceral obesity, and preserved kidney function, and explore whether MAFLD is associated with hyperfiltration. Methods: We analyzed data from 6697 Spanish civil servants, aged 18-65 years, with fasting plasma glucose & GE; 100 and & LE; 125 mg/dL (prediabetes, ADA), waist circumference & GE; 94 cm in men and & GE; 80 cm in women (visceral obesity, IDF) and de-indexed estimated glomerular filtration rate (eGFR) & GE; 60 ml/min, collected during occupational health visits. The association between MAFLD and hyperfiltration (eGFR > age- and sex-specific 95th percentile) was tested by multivariable logistic regression analyses. Results: Overall, 4213 patients (62.9%) had MAFLD, and 330 (4.9%) were hyperfiltering. MAFLD was more frequent in hyperfiltering than in non-hyperfiltering subjects (86.4% vs 61.7%, P < 0.001). BMI, waist circumference, systolic, diastolic, mean arterial pressure, and prevalence of hypertension were higher in hyperfiltering than in non-hyperfiltering subjects (P < 0.05). MAFLD was independently associated with hyperfiltration, even after adjusting for common confounders [OR (95% CI): 3.36 (2.33-4.84), P < 0.001]. In stratified analyses MAFLD potentiated age-related eGFR decline vs. non-MAFLD (P < 0.001). Conclusions: More than half of subjects with prediabetes, visceral obesity and eGFR & GE; 60 ml/min presented MAFLD that was associated with hyperfiltration and potentiated the age-related eGFR decline.