Chronic Kidney Disease and Mortality in Non-alcoholic Fatty Liver Disease Patients

Evidence Based Practice 1
Chronic Kidney Disease is Independently Associated with Increased Mortality in
Patients with Non-alcoholic Fatty Liver Disease
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Evidence Based Practice 2
Abstract
The study by Paik et al. (2018) was aimed at examining the relationship between the varying
phases of Chronic Kidney Disease (CKD) and death in the patient with non-alcoholic fatty
liver disease (NAFLD). The authors used the NHANES-III mortality files and ascertained
NAFLD using hepatic ultrasound. The impact of CKD on cardiovascular death rate was
examined using the multivariable Cox proportional hazard model. The study found out that
overall mortality rate was linked to NAFLD and advanced phases of CKD.
Background Information
Studies have shown CKD to be one of the primary public health issues that cause high death
rates, illness and high treatment costs (Gansevoort et al., 2013). There is also a strong
relationship between CKD and metabolic disorders such as cardiovascular diseases (CVD)
(Gansevoort et al., 2013). NAFLD is a significant liver disorder related to metabolic
syndrome (MS) (Younossi et al., 2018) and at a worldwide prevalence of 25% (Younossi et
al., 2016). The NAFLD patients are estimated to be at a higher risk of CVD (Targher et al.,
2010). The study by Kim et al. (2013) indicated that the primary cause of death in NAFLD
patients was cardiovascular disease.
NAFLD shares several risk factors with chronic illnesses and is regarded as the extrahepatic
manifestation (EHM) of NAFLD (Younossi et al., 2018). Some of the most commonly shared
characteristics of the MS with regard to CKD and NAFLD are insulin resistance, diabetes
mellitus, and obesity (Armstrong et al., 2014). Furthermore, both of the illnesses are linked
with an elevated risk of cardiovascular diseases. Notwithstanding the existence of this tie, its
association with mortality by making use of data that is population-based has not been
adequately addressed.

Evidence Based Practice 3
Critical Approach
Methods and Results
The study design is not expressly identified in the study. However, the study adopted a cohort
design which is of benefit because it is less costly and consumes minimal time than random
control trials (Song and Chung, 2010). Song and Chung (2010) assert that a cohort study is
the most appropriate for assessing and comparing the effectiveness of two or more
interventions. The authors do not, however, justify the use of a cohort approach, thus creating
doubt on not only its appropriateness but also the credibility of the findings (Von Elm et al.,
2014). The authors indicate the source of data “NHANES -III -linked mortality files” which
have been described as comprehensive and reliable in other studies by Younossi et al. (2012).
This also implies that the findings will most likely be reliable. The comparison being made in
the research is between NAFLD and CKD about their relationship about mortality.
Furthermore, the study provides a clear definition of the two variables. The restriction of the
study to subjects that meet the inclusion criteria only minimises selection bias (Song and
Chung, 2010). The results are comprehensive enough to be understood. The rate of
proportion between the exposed and unexposed variables is presented using percentages and
confidence intervals. This makes the results more precise and reduces any bias due to
confounding. Additionally, the observable difference due to the comparison increases the
internal validity of the study (Song and Chung, 2010).
Data Presentation
The analysed data was presented under different themes and compared to each other
according to the findings, and the difference noted. For instance, the characteristics the
cohorts have been presented separately and comparatively with the variables of each section